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Brief Contents

PART ONE MEDICAL-SURGICAL CASES, 1

Chapter 1 Cardiovascular Disorders, 1

Chapter 2 Respiratory Disorders, 83

Chapter 3 Musculoskeletal Disorders, 149

Chapter 4 Gastrointestinal Disorders, 189

Chapter 5 Genitourinary Disorders, 235

Chapter 6 Neurologic Disorders, 273

Chapter 7 Endocrine Disorders, 341

Chapter 8 Immunologic Disorders, 367

Chapter 9 Oncologic and Hematologic Disorders, 393

PART TWO PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES, 439

Chapter 10 Pediatric Disorders, 439

Chapter 11 Maternal and Obstetric Disorders, 505

Chapter 12 Women's Health Disorders, 533

Chapter 13 Psychiatric Disorders, 559

PART THREE OTHER/ADVANCED CASES, 591

Chapter 14 Alternative Therapies, 591
Chapter 15 Patients with Multiple Disorders, 599
Chapter 16 Emergency Situations, 625
Appendix: Abbreviations and Acronyms, 663
Illustration Credits, 669
 5TH EDITION

Critical
Winningham's

Thinking Cases
In Nursing
Medical-Surgical, Pediatric,
Maternity, and Psychiatric

MARIANN HARDING, MSN, RN

Associate Professor
Department of Nursing
Kent State University at Tuscarawas
New Philadelphia, Ohio

JULIE S. SNYDER, MSN, RN-BC

Adjunct Faculty
School of Nursing
Old Dominion University
Norfolk, Virginia

BARBARA A. PREUSSER†, PHD, FNPC

Family Nurse Practitioner
Veterans Administration Medical Center
Salt Lake City, Utah

Deceased
†
3251 Riverport Lane
St. Louis, Missouri 63043

WINNINGHAM'S CRITICAL THINKING CASES IN NURSING:

MEDICAL-SURGICAL, PEDIATRIC, MATERNITY, AND PSYCHIATRIC ISBN: 978-0-323-08325-6

Copyright © 2013 by Mosby, Inc., an affiliate of Elsevier Inc.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including ­photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, ­methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a ­professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most cur-
rent information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or ­formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own ­experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any ­liability
for any injury and/or damage to persons or property as a matter of products liability, negligence or ­otherwise, or
from any use or operation of any methods, products, instructions, or ideas contained in the ­material herein.

Previous editions copyrighted 2009, 2005, 2001, 1996

Library of Congress Cataloging-in-Publication Data

Harding, Mariann.
Winningham's critical thinking cases in nursing : medical-surgical, pediatric, maternity, and psychiatric /
Mariann Harding, Julie S. Snyder, Barbara A. Preusser. – 5th ed.
   p. ; cm.
Critical thinking cases in nursing
Rev. ed. of: Critical thinking in medical-surgical settings / Maryl L. Winningham and Barbara A. Preusser. 2nd
ed. c2011.
Includes bibliographical references.
ISBN 978-0-323-08325-6 (pbk. : alk. paper)
I. Snyder, Julie S. II. Preusser, Barbara A. III. Winningham, Maryl Lynne, 1947–2001. Critical thinking in
medical-surgical settings. IV. Title. V. Title: Critical thinking cases in nursing.
[DNLM: 1. Nursing Process–Case Reports. 2. Nursing Process–Problems and Exercises. 3. Nursing Care–
Case Reports. 4. Nursing Care–Problems and Exercises. WY 18.2]
610.73–dc23 2012003221

Executive Content Strategist: Lee Henderson

Content Development Specialist: Jacqueline Twomey
Publishing Services Managers: Hemamalini Rajendrababu & Deborah L. Vogel
Project Managers: Anitha Sivaraj & John W. Gabbert
Design Direction: Karen Pauls

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 To Drs. Maryl L. Winningham and Barbara A. Preusser

Drs. Winningham and Preusser, authors of this text for the previous four editions,
dedicated their lives to the care of others and the pursuit of excellence in nursing practice.
They have bequeathed a nursing heritage of integrity, excellence, courage, and service
to their students, ­colleagues, and readers.
This page intentionally left blank
Contributors

Ann Campbell, RN, MSN, CPNP Sara B. Forbus, MSN, RN

Faculty Faculty
School of Nursing School of Nursing
Old Dominion University Old Dominion University
Norfolk, Virginia Norfolk, Virginia

Contributors to Previous Editions

Elizabeth Jane Bell, MSN, ANPc Janet G. Madsen, PhD
Lesley A. Black, BSN, MS, ANPc, CWOCN Debra Ann Mills, RN, MS
Kent Blad, MS, FNPc, ACNP-C, FCCM Jeanie O'Donnell, MSN
Jamie Clinton-Lont, BSN, FNPc Deb Plasman-Coles, PAc
Susan L. Croft, BSN, MS Laura Lee Scott, MSN, FNPc
Joyce Foster, PhD, CNM, FACNM, FAAN Mary Seegmiller, MSN
Shellagh Gutke, BSN, CWOCN Sandra Smeeding, MS, FNPc
Nancy Hayden, MSN, FNPc Deborah D. Smith, BSN
Sondra Heaston, MS, FNPc, CEN Ann Speirs, BSN
Janice Hulbert, RN, MS Ronald Ulberg, BSN, MSN
Lisa Jensen, BSN, MS, APRN, CS Kristy Vankatwyk, MSN, FNPc
Stephanie C. Kettendorf, MS, RN, CNS, NCBF Annette S. Wendel, BSN
Julie Killebrew, BSN, MS Wendy Whitney, MSN, FNPc, CANP
Karen Kone, BSN, ACRN Mary Youtsey, BSN, CDE
Kathleen Kuntz, MSN, APRN, SANE

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. v
Reviewers

Diane K. Daddario, MSN, ACNS-BC, RN, Jamie Lynn Jones, MSN, RN

BC, CMSRN Assistant Professor, Nursing
Nurse Specialist University of Arkansas at Little Rock
Geisinger Medical Center Little Rock, Arkansas
Danville, Pennsylvania;
Staff Nurse Tamara M. Kear, PhD, MSN, RN
Evangelical Community Hospital Assistant Professor of Nursing
Lewisburg, Pennsylvania; Villanova University
Nursing Instructor Villanova, Pennsylvania
Pennsylvania College of Technology
Williamsport, Pennsylvania Cheryl A. Lehman, PhD, RN, CNS-BC,
RN-BC, CRRN
Jennifer Duhon, RN, MS CNS Program Coordinator
Director of Health Services Department of Health Restoration &
Lutheran Senior Services Care Systems Management (HRCSM)
Peoria, Illinois Clinical Associate Professor
The University of Texas Health Science
Sara B. Forbus, MSN, RN Center at San Antonio
Faculty San Antonio, Texas
School of Nursing
Old Dominion University Casey Norris, MSN, BSN
Norfolk, Virginia Adjunct Instructor, Nursing
South College
Mimi Haskins, MS, RN, CMSRN Pulmonary Clinical Nurse Specialist
Nursing Staff Development Instructor East Tennessee Children's Hospital
Roswell Park Cancer Institute Knoxville, Tennessee
Buffalo, New York
Brenda K. Shelton, MS, RN, CCRN, AOCN
Suzanne Jed, MSN, APRN-BC The Sidney Kimmel Cancer Center at Johns
Clinical Instructor, Family Medicine Hopkins
Keck School of Medicine Baltimore, Maryland
University of Southern California
Los Angeles, California

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

vi Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
Introduction

There is an urgent need for nurses with well-practiced critical thinking skills. As new graduates,
you will make decisions and take actions of an increasingly sophisticated nature. You will encoun-
ter problems you have never seen or heard about during your classroom and clinical experiences.
You are going to have to make complex decisions with little or no guidance and limited resources.
We want you to be exposed to as much as possible during your student days, but more impor-
tantly, we want you to learn to think. You cannot memorize your way out of any situation, but you
can think your way out of any situation. We know that students often learn more and faster when
they have the freedom to make mistakes. This book is designed to allow you to experiment with
finding answers without the pressure of someone's life hanging in the balance. We want you to do
well. We want you to be the best. It is our wish for you to grow into confident, competent profes-
sionals. After all, someday we will be one of those people you care for, and when that day comes, we
want you to be very, very good at what you do!

What Is Critical Thinking?

Critical thinking is not memorizing lists of facts or the steps of procedures. Instead, critical think-
ing is an analytical process that can help you think through a problem in an organized and efficient
manner. Five steps are involved in critical thinking. Thinking about these steps may help you when
you work through the questions in your cases. Here are the five steps with an explanation of what
they mean.

1. Recognize and define the problem by asking the right questions: Exactly what is it you need
to know? What is the question asking?
2. Select the information or data necessary to solve the problem or answer the question: First
you have to ask whether all the necessary information is there. If not, how and where can
you get the additional information? What other resources are available? This is one of the
most difficult steps. In real clinical experiences, you rarely have all of the information,
so you have to learn where you can get necessary data. For instance, patient and family
interviews, nursing charting, the patient medical chart, laboratory data on your computer,
your observations, and your own physical assessment can help you identify important clues.
Of course, information can rapidly become outdated. To make sure you are accessing the
most current and accurate information, you will occasionally need to use the Internet to
answer a question.
3. Recognize stated and unstated assumptions; that is, what do you think is or is not true?
Sometimes answers or solutions seem obvious; just because something seems obvious doesn't
mean it is correct. You may need to consider several possible answers or solutions. Consider
all clues carefully and do not dismiss a possibility too quickly. Remember, “You never find an
answer you don't think of.”

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Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. vii
 INTRODUCTION

4. Formulate and select relevant and/or potential decisions. Try to think of as many possibilities
as you can. Consider the pros and cons of the consequences of making each decision. What is
the best answer/solution? What could go wrong? This requires considering many different
angles. In today's health care settings, decision-making often requires balancing the well-
being needs of the patient, the preferences and concerns of the patient and caregiver, and
financial limitations imposed by the reimbursement system. In making decisions, you
need to take into account all relevant factors. Remember, you may need to explain why you
rejected other options.
5. Draw a valid, informed conclusion: Consider all data; then determine what is relevant and
what makes the most sense. Only then should you draw your conclusion.

It may look as if this kind of thinking comes naturally to instructors and experienced nurses.
You can be certain that even experienced professionals were once where you are now. The rapid and
sound decision-making that is essential to good nursing requires years of practice. The practice of
good clinical thinking leads to good thinking in clinical practice. This book will help you practice
the important steps in making sound clinical judgments until the process starts to come naturally.
The practice of good clinical thinking leads to good thinking in clinical practice.

The “How to” of Case Studies

When you begin each case, read through the whole story once, from start to finish, getting a general
idea of what it is about. Write down things you have to look up. This will help you move through
the case smoothly and get more out of it. How much you have to look up will depend on where you
are in your program, what you know, and how much experience you already have. Preparing cases
will become easier as you advance in your program.

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

viii Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
Acknowledgments

We would like to express our appreciation to the editorial Elsevier staff—Kristen Geen, Lee
Henderson, Jamie Horn, and Jacqueline Twomey—for their professional support and contributions
in guiding this text to publication. We extend a special thanks to our reviewers who gave us helpful
suggestions and insights as we developed this edition.
Mariann's gratitude goes to the most important people in her life—her husband, Jeff, and her
daughters, Kate and Sarah—for their giving of love, support, and time during the months of writ-
ing. She gives a special thanks to her students, colleagues, and patients; each has taught her much
and fueled her passion for nursing and education. Finally, Mariann gives her thanks to God, who
made all things possible.
Julie thanks her husband, Jonathan, for his love, support, and patience during this project. She is
grateful for the encouragement from daughter Emily, son-in-law Randy, and parents Willis and Jean
Simmons. Julie appreciates the hard work of colleagues Ann Campbell and Sara Forbus as contribu-
tors to this edition. She is especially thankful to the students, whose eagerness to learn is an inspira-
tion. Most importantly, Julie gives thanks to God, our source of hope and strength.

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This page intentionally left blank
Contents

PART ONE Medical-Surgical Cases, 1

1 Cardiovascular Disorders, 1 Case Study 35, 159
Case Study 1, 1 Case Study 36, 165
Case Study 2, 5 Case Study 37, 169
Case Study 3, 11 Case Study 38, 173
Case Study 4, 17 Case Study 39, 177
Case Study 5, 21 Case Study 40, 181
Case Study 6, 25 Case Study 41, 185
Case Study 7, 31
Case Study 8, 35
4 Gastrointestinal Disorders, 189
Case Study 9, 39 Case Study 42, 189
Case Study 10, 43 Case Study 43, 193
Case Study 11, 47 Case Study 44, 197
Case Study 12, 53 Case Study 45, 201
Case Study 13, 57 Case Study 46, 207
Case Study 14, 63 Case Study 47, 211
Case Study 15, 67 Case Study 48, 217
Case Study 16, 73 Case Study 49, 221
Case Study 17, 79 Case Study 50, 225
Case Study 51, 229
2 Respiratory Disorders, 83
Case Study 18, 83 5 Genitourinary Disorders, 235
Case Study 19, 87 Case Study 52, 235
Case Study 20, 91 Case Study 53, 239
Case Study 21, 95 Case Study 54, 243
Case Study 22, 101 Case Study 55, 247
Case Study 23, 105 Case Study 56, 251
Case Study 24, 109 Case Study 57, 257
Case Study 25, 113 Case Study 58, 261
Case Study 26, 117 Case Study 59, 265
Case Study 27, 123 Case Study 60, 269
Case Study 28, 127
Case Study 29, 133 6 Neurologic Disorders, 273
Case Study 30, 139 Case Study 61, 273
Case Study 31, 143 Case Study 62, 277
Case Study 63, 281
3 Musculoskeletal Disorders, 149 Case Study 64, 285
Case Study 32, 149 Case Study 65, 289
Case Study 33, 153 Case Study 66, 293
Case Study 34, 155 Case Study 67, 299
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Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. xi
 CONTENTS

Case Study 68, 303 8 Immunologic Disorders, 367

Case Study 69, 307
Case Study 82, 367
Case Study 70, 311
Case Study 83, 371
Case Study 71, 317
Case Study 84, 375
Case Study 72, 323
Case Study 85, 379
Case Study 73, 327
Case Study 86, 383
Case Study 74, 331
Case Study 87, 387
Case Study 75, 337

7 Endocrine Disorders, 341

9 Oncologic and Hematologic Disorders, 393
Case Study 88, 393
Case Study 76, 341
Case Study 89, 397
Case Study 77, 345
Case Study 90, 401
Case Study 78, 349
Case Study 91, 405
Case Study 79, 353
Case Study 92, 409
Case Study 80, 359
Case Study 93, 413
Case Study 81, 363
Case Study 94, 419
Case Study 95, 425
Case Study 96, 429
Case Study 97, 433

PART TWO Pediatric, Maternity, and Psychiatric Cases, 439

10 Pediatric Disorders, 439 Case Study 117, 521
Case Study 98, 439 Case Study 118, 525
Case Study 99, 441 Case Study 119, 529
Case Study 100, 447
Case Study 101, 451 12 Women’s Health Disorders, 533
Case Study 102, 455 Case Study 120, 533
Case Study 103, 459 Case Study 121, 537
Case Study 104, 465 Case Study 122, 541
Case Study 105, 471 Case Study 123, 547
Case Study 106, 475 Case Study 124, 551
Case Study 107, 479 Case Study 125, 555
Case Study 108, 483
Case Study 109, 487 13 Psychiatric Disorders, 559
Case Study 110, 491 Case Study 126, 559
Case Study 111, 497 Case Study 127, 563
Case Study 112, 501 Case Study 128, 567
Case Study 129, 571
11 Maternal and Obstetric Disorders, 505 Case Study 130, 575
Case Study 113, 505 Case Study 131, 579
Case Study 114, 509 Case Study 132, 583
Case Study 115, 513 Case Study 133, 587
Case Study 116, 517

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xii Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
    Contents

PART THREE Other/Advanced Cases, 591

14 Alternative Therapies, 591 16 Emergency Situations, 625
Case Study 134, 591 Case Study 141, 625
Case Study 135, 595 Case Study 142, 629
Case Study 143, 633
15 Patients with Multiple Disorders, 599 Case Study 144, 635
Case Study 136, 599 Case Study 145, 639
Case Study 137, 605 Case Study 146, 643
Case Study 138, 609 Case Study 147, 647
Case Study 139, 615 Case Study 148, 651
Case Study 140, 619 Case Study 149, 655
Case Study 150, 659

APPENDIX: Abbreviations and Acronyms, 663

ILLUSTRATION CREDITS, 669

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This page intentionally left blank
PART ONE Medical-Surgical Cases

Cardiovascular Disorders 1

1 Cardiovascular
Case Study 1
Name Class/Group Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

XX
scenario
M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure
(HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come
to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After fur-
ther questioning, you learn she is strictly following the fluid and salt restriction ordered during her last
hospital admission. She reports gaining 1 to 2 pounds every day since her discharge.

1. What error in teaching most likely occurred when M.G. was discharged 10 days ago?

CAsE sTudY PRoGREss

During the admission interview, the nurse makes a list of the medications M.G. took at home.

■ Chart View

Nursing Assessment: Medications Taken at Home

Enalapril (Vasotec) 5 mg PO bid
Pioglitazone (Actos) 45 mg PO every morning
Furosemide (Lasix) 40 mg/day PO
Potassium chloride 20 mEq/day PO

2. Which of these medications may have contributed to M.G.'s heart failure? Explain.

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. 1
 PART 1 MEdiCAl-suRGiCAl CAsEs

3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work

to reduce heart failure? (Select all that apply.) ACE inhibitors:
a. prevent the conversion of angiotensin I to angiotensin II.
b. cause systemic vasodilation.
c. promote the excretion of sodium and water in the renal tubules.
d. reduce preload and afterload.
e. increase cardiac contractility.
1 Cardiovascular

f. block sympathetic nervous system stimulation to the heart.

CAsE sTudY PRoGREss

After reviewing M.G.'s medications, the physician writes these medication orders:
■ Chart View

Medication Orders
Enalapril (Vasotec) 5 mg PO bid
Carvedilol (Coreg) 100 mg PO every morning
Glipizide (Glucotrol) 10 mg PO every morning
Furosemide (Lasix) 80 mg IV push (IVP) now, then 40 mg/day IVP
Potassium chloride (K-Dur) 20 mEq/day PO

4. What is the rationale for changing the route of the furosemide (Lasix)?

5. You administer furosemide (Lasix) 80 mg IVP. Identify three parameters you would use to
monitor the effectiveness of this medication.

6. What laboratory tests should be ordered for M.G. related to the order for furosemide
(Lasix)? (Select all that apply.)
a. Magnesium level
b. Sodium level

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2 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 Cardiovascular Disorders CASE STUDY 1

c. Complete blood count (CBC)

d. Serum glucose levels
e. Potassium level
f. Coagulation studies

1 Cardiovascular
7. What is the purpose of the beta blocker carvedilol? It is given to:
a. increase the contractility of the heart
b. cause peripheral vasodilation
c. increase urine output
d. reduce cardiac stimulation by catecholamines

CASE STUDY PROGRESS

The next day, M.G. has shown only slight improvement, and digoxin (Lanoxin) 125 mcg PO daily is added
to her orders.

8. What is the action of the digoxin? Digoxin:

a. causes systemic vasodilation.
b. promotes the excretion of sodium and water in the renal tubules.
c. increases cardiac contractility and cardiac output.
d. blocks sympathetic nervous system stimulation to the heart.

9. Which findings from M.G.'s assessment would indicate an increased possibility of digoxin
toxicity? Explain your answer.
a. Serum potassium level of 2.2 mEq/L
b. Serum sodium level of 139 mEq/L
c. Apical heart rate of 64 beats/minute
d. Digoxin level 1.6 ng/mL

10. When you go to give the digoxin, you notice that it is available in milligrams (mg) not
micrograms (mcg). Convert 125 mcg to mg.

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Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. 3
 PART 1 MEDICAL-SURGICAL CASES

11. M.G.'s symptoms improve with IV diuretics and the digoxin. She is placed back on oral
furosemide (Lasix) once her weight loss is deemed adequate to achieve a euvolemic
state. What will determine whether the oral dose will be adequate to consider her for
discharge?
1 Cardiovascular

12. M.G. is ready for discharge. Using the mnemonic MAWDS, what key management concepts
should be taught to prevent relapse and another admission?

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4 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 CARdiovAsCulAR disoRdERs CASE STUDY 2

Case Study 2
Name Class/Group Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

1 Cardiovascular
XX
scenario
M.P. is a 65-year-old African-American woman who comes to your clinic for a follow-up visit. She was
diagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diuretic
but stopped taking it 2 weeks ago because “it made me dizzy and I kept getting up during the night to
empty my bladder.” During today's clinic visit, she expresses fear because her mother died of a cerebro-
vascular accident (CVA, stroke) at her age, and M.P. is afraid she will suffer the same fate. She states, “I've
never smoked and I don't drink, but I am so afraid of this high blood pressure.” You review the data on her
past clinic visits.

■ Chart View

Family History
Mother, died at age 65 years of CVA
Father, died at age 67 years of myocardial infarction (MI)
Sister, alive and well, age 62 years
Brother, alive, age 70 years, has coronary artery disease, HTN, type II diabetes mellitus (DM)
Patient Past History
Married for 45 years, two children, alive and well, six grandchildren
Cholecystectomy, age 42 years
Hysterectomy, age 48 years
Blood Pressure Assessments
January 2: 150/92
January 31: 156/94 (Given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every morning)
February 28: 140/90

1. According to the most recent Joint National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood Pressure, M.P.'s blood pressure falls under which
classification?

2. What could M.P. be doing that is causing her nocturia?

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 PART 1 MEDICAL-SURGICAL CASES

CASE STUDY PROGRESS

During today's visit, M.P.'s vital signs were BP: 162/102, P: 78, R: 16, T: 98.2 ° F (36.8 ° C). Her most recent
basic metabolic panel (BMP) and fasting lipids were within normal limits. Her height is 5 ft, 4 in., and she
weighs 110 lb. She tells you that she tries to go on walks but does not like to walk alone so has done so
only occasionally.

3. What risk factors does M.P. have that increase her risk for cardiovascular disease?
1 Cardiovascular

CASE STUDY PROGRESS

Because M.P.'s BP continues to be high, the internist decides to put her on another drug and recommends
that she try again with the HCTZ.

4. According to national guidelines, what drug category or categories are recommended for
M.P. at this time?

5. M.P. goes on to ask whether there is anything else she should do to help with her HTN. She
asks, “Do I need to lose weight?” Look up her height and weight for her age on a body mass
index chart. Is she considered overweight?

6. What nonpharmacologic lifestyle alteration measures might help someone like M.P. control
her BP? (List two examples and explain.)

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 CHAPTER 1 Cardiovascular Disorders CASE STUDY 2

1 Cardiovascular
CASE STUDY PROGRESS
The internist decreases M.P.'s HCTZ dosage to 12.5 mg PO daily and adds a prescription for benazepril
(Lotensin) 5 mg daily. M.P. is instructed to return to the clinic in 1 week to have her blood work checked.
She is also instructed to monitor her BP at least twice a week and return for a medication management
appointment in 1 month with her list of BP readings.

7. Why did the internist decrease the dose of the HCTZ?

8. You provide M.P. with education about the common side effects of benazepril, which can
include which conditions? (Select all that apply.)
a. Headache
b. Cough
c. Shortness of breath
d. Constipation
e. Dizziness

9. It is sometimes difficult to remember whether you've taken your medication. What

techniques might you teach M.P. to help her remember to take her medication each day?
(Name at least two.)

10. After the teaching session, which statement by M.P. indicates a need for further
instructions?
a. “I need to rise up slowly when I get out of bed or out of a chair before standing up.”
b. “I will leave the salt shaker off the table and not salt my food when I cook.”
c. “It's okay to skip a few doses if I am feeling bad as long as it's just for a few days.”
d. “I will call if I feel very dizzy, weak, or short of breath while on this medicine.”

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 PART 1 MEdiCAl-suRGiCAl CAsEs

CAsE sTudY PRoGREss

M.P. returns in 1 month for her medication management appointment. She tells you she is feeling fine
and does not have any side effects from her new medication. Her BP, checked twice a week at the senior
center, ranges from 132 to 136/78 to 82 mm Hg.

11. When someone is taking HCTZ and an ACE inhibitor, such as benazepril, what laboratory
tests would you expect to be monitored?
1 Cardiovascular

■ Chart View

Laboratory Test Results (Fasting)

Potassium 3.6 mEq/L
Sodium 138 mEq/L
Chloride 100 mEq/L
CO2 28 mEq/L
Glucose 112 mEq/L
Creatinine 0.7 mg/dL
BUN 18 mg/dL
Magnesium 1.9 mEq/L

12. What lab results, if any, are of concern at this time?

13. You take M.P.'s BP and get 134/82 mm Hg. She asks whether these BP readings are okay. On
what do you base your response?

14. List at least three important ways you might help her maintain her success.

CAsE sTudY ouTCoME

M.P. comes in for a routine follow-up visit 3 months later. She continues to do well on her daily BP drug
regimen, with average BP readings of 130/78 mm Hg. She participates in a senior citizens group-walking
program at the local mall. She admits she has not done as well with decreasing her salt intake but that she
is trying. She tells you she was recently at a luncheon with her garden club and that most of those women
take different BP pills than she does. She asks why their pills are different shapes and colors.
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8 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 Cardiovascular Disorders CASE STUDY 2

15. How can you explain the difference to M.P.?

1 Cardiovascular

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Intentionally left as blank
 CHAPTER 1 CARdiovAsCulAR disoRdERs CASE STUDY 3

Case Study 3
Name Class/Group Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

1 Cardiovascular
XX
scenario
You are a nurse at a freestanding cardiac prevention and rehabilitation center. Your new patient in
risk-factor modification is B.T., a 41-year-old traveling salesman, who is married and has three children. He
tells you that his work does not let him slow down. During a recent evaluation for chest pain, he underwent
a cardiac catheterization procedure that showed moderate single-vessel disease with a 50% stenosis in
the mid right coronary artery (RCA). He was given a prescription for sublingual (SL) nitroglycerin (NTG),
told how to use it, and referred to your cardiac rehabilitation program for sessions of 3 days a week. B.T.'s
wife comes along to help him with healthy lifestyle changes. You take a nursing history, as indicated in
the following.

■ Chart View

Family History
Father died suddenly at age 42 of a myocardial infarction (MI)
Mother (still living) had a quadruple coronary artery bypass graft (CABG × 4) at age 52
Past History and Current Medications
Metoprolol (Lopressor) 25 mg PO every 12 hours
Aspirin (ASA) 325 mg per day PO
Simvastatin (Zocor) 20 mg PO every evening
Lifestyle Habits
Smokes an average of 1½ packs of cigarettes per day (PPD) for the past 20 years
Drinks an “occasional” beer, and “a 6-pack every weekend when watching football”
Dietary history: High in fried and fast foods because of his traveling
Exercise: “I don't have time to take walks.”
General Assessment
White Male
Weight 235 lb
Height 5 ft, 8 in.
Waist circumference 48 in.
Blood pressure 148/88 mm Hg
Pulse 82 beats/min
Respiratory rate 18 breaths/min
Temperature 98.4° F (36.9° C)

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 PART 1 MEdiCAl-suRGiCAl CAsEs

1. Calculate B.T.'s smoking history in terms of pack-years.

2. There are several risk factors for coronary artery disease (CAD). For each risk factor listed,
mark whether it is nonmodifiable or modifiable.
a. Age
1 Cardiovascular

b. Smoking
c. Family history of CAD
d. Obesity
e. Physical inactivity
f. Gender
g. Hypertension
h. Diabetes mellitus
i. Hyperlipidemia
j. Ethnic background
k. Stress
l. Excessive alcohol use

3. Circle the nonmodifiable and modifiable risk factors that apply to B.T.

CAsE sTudY PRoGREss

You review B.T.'s most recent lab results.

■ Chart View

Laboratory Testing (Fasting)

Total cholesterol 240 mg/dL
HDL 35 mg/dL
LDL 112 mg/dL
Triglycerides 178 mg/dL

4. Which lab values are of concern at this time? Explain your answers.

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12 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 Cardiovascular Disorders CASE STUDY 3

5. B.T. asks you, “So, how is my ‘good cholesterol’ doing today?” Which is considered the “good
cholesterol,” and why? What do his HDL and LDL levels indicate to you?

1 Cardiovascular
CASE STUDY PROGRESS
B.T. laughingly tells you he believes in the five all-American food groups: salt, sugar, fat, chocolate,
and caffeine.

6. Identify health-related problems in this case description; the problem that is potentially life
threatening should be listed first.

7. Of all of his behaviors, which one is the most significant in promoting cardiac disease?

8. What is the highest priority problem that you need to address with B.T.? How will you
determine this? Identify the teaching strategy you would use with him.

9. What is the second problem you would work with B.T. to change? Identify an appropriate
strategy to resolve the problem.

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 PART 1 MEDICAL-SURGICAL CASES
1 Cardiovascular

10. B.T.'s wife takes you aside and tells you, “I'm so worried for B. I grew up in a really
dysfunctional family where there was a lot of violence. B. has been so good to the kids and
me. I'm so worried I'll lose him that I have nightmares about his heart stopping. I find
myself suddenly awakening at night just to see if he's breathing.” How are you going to
respond?

CASE STUDY PROGRESS

Six weeks after you start working with B.T., he admits that he has been under a lot of stress. He is walking
on the treadmill and rubs his chest and says, “It feels really heavy on my chest right now.” You feel his pulse
and note that his skin is slightly diaphoretic and that he is agitated and appears to be anxious.

11. What is the first action you are going to do? What other information will you obtain?
Explain.

12. B.T. is still uncomfortable, and he has an unopened bottle of sublingual nitroglycerin (SL
NTG) tablets. You decide to give him one tablet. After 5 minutes, which is the appropriate
action to take?
a. If the chest discomfort is relieved, call 911.
b. If the chest discomfort is not relieved, give another SL NTG tablet, and wait 5 minutes
more.
c. If the chest discomfort is not relieved, have someone else call 911, while you give B.T.
another SL NTG tablet.
d. If the chest discomfort is not relieved, do a 12-lead electrocardiogram (ECG) to look for
ischemic changes, and call 911.

13. What other actions will you take at this time?

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 CHAPTER 1 Cardiovascular Disorders CASE STUDY 3

14. Five minutes after the first NTG tablet, B.T. states that the discomfort is still there and only
slightly relieved. Explain what you can expect to be doing while waiting for emergency
medical system (EMS) to arrive.

1 Cardiovascular
CASE STUDY OUTCOME
B.T. is transported to the ED of a local hospital and undergoes another cardiac catheterization with
­coronary stent placement.

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Intentionally left as blank
 CHAPTER 1 CARdiovAsCulAR disoRdERs CASE STUDY 4

Case Study 4
Name Class/Group Date____________________
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

1 Cardiovascular
XX
scenario
S.P. is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately
2 years ago but has become significantly worse in the past 4 months. The pain is precipitated by exercise
and is relieved with rest. Two years ago, S.P. could walk two city blocks before having to stop because of
leg pain. Today, he can barely walk across the yard. S.P. has smoked two to three packs of cigarettes per
day (PPD) for the past 45 years. He has a history of coronary artery disease (CAD), hypertension (HTN),
peripheral vascular disease (PVD), and osteoarthritis. Surgical history includes quadruple coronary artery
bypass graft (CABG × 4) 3 years ago. He has had no further symptoms of cardiopulmonary disease since
that time, even though he has not been compliant with the exercise regimen his cardiologist prescribed,
he continues to eat anything he wants, and continues to smoke two to three PPD. Other surgical history
includes open reduction internal fixation of the right femoral fracture 20 years ago.
S.P. is in the clinic today for a routine semiannual follow-up appointment with his primary care
provider. As you take his vital signs, he tells you that, besides the calf pain, he is experiencing right hip
pain that gets worse with exercise, the pain doesn't go away promptly with rest, some days are worse
than others, and his condition is not affected by a resting position.

■ Chart View

General Assessment
Weight 261 lb
Height 5 ft, 10 in.
Blood pressure 163/91 mm Hg
Pulse 82 beats/min
Respiratory rate 16 breaths/min
Temperature 98.4° F (36.9° C)
Laboratory Testing (Fasting)
Cholesterol 239 mg/dL
Triglycerides 150 mg/dL
HDL 28 mg/dL
LDL 181 mg/dL
Current Medications
Lisinopril (Zestril) 20 mg/day
Metoprolol (Lopressor) 25 mg twice a day
Aspirin 325 mg/day
Simvastatin (Zocor) 20 mg/day

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 PART 1 MEDICAL-SURGICAL CASES

1. What are the likely sources of his calf pain and his hip pain?
1 Cardiovascular

2. S.P. has several risk factors for claudication. From his history, list two risk factors, and explain
the reason they are risk factors.

3. You decide to look at S.P.'s lower extremities. What signs do you expect to find with
intermittent claudication? (Select all that apply.)
a. Cool or cold extremity
b. Thin, dry, and scaly skin
c. Brown discoloration of the skin
d. Decreased or absent pedal pulses
e. Ankle edema
f. Thick, brittle nails

4. Where would you expect S.P. to complain of pain if he had superficial femoral artery
stenosis? Popliteal stenosis?

5. What is the purpose of the daily aspirin listed in his current medication?

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 CHAPTER 1 Cardiovascular Disorders CASE STUDY 4

CASE STUDY PROGRESS

S.P.'s primary care provider has seen him and wants you to schedule the patient for an ankle-brachial
index (ABI) test to determine the presence of arterial blood flow obstruction. You confirm the time and
date of the procedure and then call S.P. at home.

6. What will you tell S.P. to do to prepare for the tests?

1 Cardiovascular
CASE STUDY PROGRESS
S.P.'s ABI results showed 0.43 right (R) leg and 0.59 left (L) leg. His primary care provider discusses these
results with him and decides to wait 2 months to see whether his symptoms improve with medication
changes and risk factor modification before deciding about surgical intervention. S.P. receives a pre-
scription for clopidogrel (Plavix) 75 mg daily and is told to discontinue the daily aspirin. In addition, S.P.
received a consult for physical therapy.

7. What do these ABI results indicate?

8. You counsel S.P. on risk factor modification. What would you address, and why?

9. How will the physical therapy help?

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 PART 1 MEDICAL-SURGICAL CASES

10. In addition to risk factor modification, what other measures to improve tissue perfusion or
to prevent skin damage should you recommend to S.P.?
1 Cardiovascular

11. S.P. tells you his neighbor told him to keep his legs elevated higher than his heart and ask for
compression stockings to keep swelling down in his legs. How should you respond?

12. S.P. has been on aspirin therapy and now will be taking clopidogrel. What is the most
important aspect of patient teaching that you will emphasize with this drug?

CASE STUDY OUTCOME

S.P. asks for nicotine patches to assist with smoking cessation and makes an appointment for a physical
therapy evaluation and a nutritional assessment. He assures you he doesn't want to lose his leg and will
be more careful in the future.

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20 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 Cardiovascular Disorders CASE STUDY 5

Case Study 5
Name Class/Group Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

1 Cardiovascular
XX
Scenario
You are the nurse working in an anticoagulation clinic. One of your patients is K.N., who has a l­ong-standing
history of an irregularly irregular heartbeat (atrial fibrillation, or A-fib) for which he takes the oral ­anticoagulant
warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve.

1. How does atrial fibrillation differ from a normal heart rhythm?

2. What is the purpose of the warfarin (Coumadin) in K.N.'s case?

CASE STUDY PROGRESS

K.N. calls your anticoagulation clinic to report a nosebleed that is hard to stop. You ask him to come into
the office to check his coagulation levels. The laboratory technician draws a PT/INR test.

3. What is a PT/INR test, and what are the expected levels for K.N.? What is the purpose of
the INR?

4. When you get the results, his INR is critical at 7.2. What is the danger of this INR level?

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 PART 1 MEDICAL-SURGICAL CASES

CASE STUDY PROGRESS

The health care provider does a brief focused history and physical examination, orders additional lab
tests, and determines that there are no signs of bleeding other than the nosebleed, which has stopped.
The provider discovers that K.N. recently went to the local urgent care center for a sinus infection and had
received a prescription for the antibiotic co-trimoxazole (sulfamethoxazole-trimethoprim) (Septra).

5. What happened when K.N. began taking the antibiotic?

1 Cardiovascular

6. What should K.N. have done to prevent this problem?

7. The provider gives K.N. a low dose of vitamin K orally, asks him to hold his warfarin dose
that evening, and asks him to come back tomorrow for another PT/INR blood draw. Why do
you tell K.N. to take the vitamin K?

8. You want to make certain K.N. knows what “hold the next dose” means. What should you
tell him?

9. K.N. asks you why his PT/INR has to be checked so soon. How will you respond?

CASE STUDY PROGRESS

K.N.'s INR the next day is 3.7, and the health care provider made no further medication changes. K.N. is
instructed to finish the remaining 2 days of antibiotics and return again in 7 days to have another PT/INR
drawn.

10. Why should the INR be checked again so soon instead of the usual monthly follow-up?

11. K.N. grumbles about all of the lab tests but agrees to follow through. You provide patient
education to K.N. and start with reviewing the signs and symptoms (S/S) of bleeding. What
are potential S/S of bleeding that should be taught to K.N.? (Select all that apply.)
a. Black, tarry stool
b. Stool that is pale in color
c. New onset of dizziness
d. Insomnia

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22 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 Cardiovascular Disorders CASE STUDY 5

e. New joint pain or swelling

f. Unexplained abdominal pain

1 Cardiovascular
12. What other patient education needs to be stressed at this time? (Identify two.)

13. Four months later, K.N. informs you that he is going to have a knee replacement next month.
What will you do with this information?

CASE STUDY PROGRESS

You know that sometimes the only needed action is to stop the warfarin (Coumadin) several days before
the surgery. Other times, the provider initiates “bridging therapy,” or stops the warfarin and provides anti-
coagulation protection by initiating low-molecular-weight heparin. After reviewing all of his anticoagula-
tion information, the provider decides that K.N. will need to stop the warfarin (Coumadin) 1 week before
the surgery and, in its place, be started on enoxaparin (Lovenox) therapy.

14. Compare the duration of action of warfarin (Coumadin) and enoxaparin (Lovenox), and
explain the reason the provider switched to enoxaparin at this time.

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 PART 1 MEDICAL-SURGICAL CASES

CASE STUDY PROGRESS

K.N. is in the office and ready for his first enoxaparin (Lovenox) injection.

15. Which nursing interventions are appropriate when administering enoxaparin? (Select all that
apply.)
a. Monitor activated partial thromboplastin (aPTT) levels.
b. Administer via intramuscular (IM) injection into the deltoid muscle.
1 Cardiovascular

c. The preferred site of injection is the lateral abdominal fatty tissue.

d. Massage the area after the injection is given.
e. Hold extra pressure over the site after the injection.

CASE STUDY OUTCOME

K.N. undergoes knee surgery without complications and does not experience any thrombotic events or
bleeding episodes during his recovery.

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24 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 CARdiovAsCulAR disoRdERs CASE STUDY 6

Case Study 6
Name Class/Group Date
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume information that
is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will
need to rewrite it.

1 Cardiovascular
XX
scenario
You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is
70-year-old J.M., a man who has been coming to the clinic for several years for management of coronary
artery disease (CAD) and hypertension (HTN). A cardiac catheterization done a year ago showed 50%
stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and
orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months.
On his last clinic visit 3 weeks ago, a chest x-ray (CXR) showed cardiomegaly, and a 12-lead electrocardio-
gram (ECG) showed sinus tachycardia with left bundle branch block (LBBB). You review his morning blood
work and initial assessment.

■ Chart View

Laboratory Testing
Chemistry
Sodium 142 mEq/L
Chloride 95 mEq/L
Potassium 3.9 mEq/L
Creatinine 0.8 mg/dL
Glucose 82 mg/dL
BUN 19 mg/dL
CBC
WBC 5400/mm3
Hgb 13 g/dL
Hct 41%
Platelets 229,000/mm3
Initial Assessment
Complains of increased fatigue and shortness of breath, especially with activity, and “waking up
gasping for breath” at night, for the past 2 days.
Vital Signs
Temperature 97.9° F (36.6° C)
Blood pressure 142/83 mm Hg
Heart rate 105 beats/min
Respiratory rate 18 breaths/min

1. As you review these results, which ones are of possible concern, and why?

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 PART 1 MEDICAL-SURGICAL CASES

2. Knowing his history and seeing his condition this morning, what further questions are you
going to ask J.M. and his daughter?
1 Cardiovascular

CASE STUDY PROGRESS

J.M. tells you he becomes exhausted and has shortness of breath climbing the stairs to his bedroom and
has to lie down and rest (“put my feet up”) at least an hour twice a day. He has been sleeping on two
­pillows for the past 2 weeks. He has not salted his food since the physician told him not to because of his
high blood pressure, but he admits having had ham and a whole bag of salted peanuts 3 days ago. He
denies having palpitations but has had a constant, irritating, nonproductive cough lately.

3. You think it's likely that J.M. has heart failure (HF). From his history, what do you identify as
probable causes for his HF?

4. You are now ready to do your physical assessment. For each potential assessment finding for
HF, indicate whether the finding indicates left-sided heart failure (L) or right-sided heart
failure (R).
1. Fatigue, weakness, especially with activity
2. Jugular (neck) vein distention
3. Dependent edema (legs and sacrum)
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26 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 CARdiovAsCulAR disoRdERs CASE STUDY 6

4. Hacking cough, worse at night

5. Enlarged liver and spleen
6. Exertional dyspnea
7. Distended abdomen
8. Weight gain
9. S3/S4 gallop
10. Crackles/wheezes in lungs

1 Cardiovascular
■ Chart View

Medication Orders
Enalapril (Vasotec) 10 mg PO twice a day
Furosemide (Lasix) 20 mg PO every morning
Carvedilol (Coreg) 6.25 mg PO twice a day
Digoxin (Lanoxin) 0.5 mg PO now, then 0.125 mg PO daily
Potassium chloride 10 mEq tablet PO once a day

CAsE sTudY PRoGREss

The physician confirms your suspicions and indicates that J.M. is experiencing symptoms of early
left-sided heart failure. Medication orders are written.

5. For each medication listed, identify its class, and describe its purpose for the treatment of HF.

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 PART 1 MEDICAL-SURGICAL CASES

6. When you go to remove the medications from the automated dispensing machine, you see
that carvedilol (Coreg CR) is stocked. Will you give it to J.M.? Explain.

7. As you remove the digoxin tablet from the automated medication dispensing machine, you
note that the dosage on the tablet label is 250 mcg. How many tablets would you give?
1 Cardiovascular

8. Based on the new medication orders, which blood test or tests should be monitored
carefully? Explain your answer.

9. When you give J.M. his medications, he looks at the potassium tablet, wrinkles his nose, and
tells you he “hates those horse pills.” He tells you a friend of his said he could eat bananas
instead. He says he would rather eat a banana every day than take one of those pills. How will
you respond?

CASE STUDY PROGRESS

This is J.M.'s first episode of significant HF. Before he leaves the clinic, you want to teach him about life-
style modifications he can make and monitoring techniques he can use to prevent or minimize future
problems.

10. List five suggestions you might make and the rationale for each.

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

28 Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 1 Cardiovascular Disorders CASE STUDY 6

1 Cardiovascular
11. You tell J.M. the combination of high-sodium foods he had during the past several days
might have contributed to his present episode of HF. He looks surprised. J.M. says, “But I
didn't add any salt to them!” To what health care professional could J.M. be referred to help
him understand how to prevent future crises? State your rationale.

12. You also include teaching about digoxin toxicity. When teaching J.M. about the signs and
symptoms of digoxin toxicity, which should be included? (Select all that apply.)
a. Dizziness when standing up
b. Visual changes
c. Loss of appetite or nausea
d. Increased urine output
e. Diarrhea

CASE STUDY OUTCOME

J.M.'s condition improves after 5 days of treatment, and he is discharged to home. He has a follow-up
appointment with a cardiologist in 2 weeks.

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.

Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. 29
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115 Maplewood av (Wych) l 241 Brock av r 33 Hunter GE 4987
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av h 63 Chaplin cres HU 3277 Marshall N Clifford h 623 Sherbourne
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(Wych) LO 2557 (act ser) — Noel F tool mkr CGE h 490 Armadale av
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Queen e — Norman opr TTC h 113 Warden av (Bch C) — Norman
tinner Rolph-Clark-Stone h 73 Rushbrooke av — Norman A insp CCM
r 242 Blackthorn av — Norman M slsmn Tor Sanitary Towel Supply h
245 Melrose av — Norman S buffer Dorn Bridge h 183 Cowan av LA
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assorter Crown Cork & Seal r 610 Pape av — Peter artist r 97 Glen rd
MI 7477 — Pharmacy (A C Marshall) 1100 Queen e GL 3910 — Philip
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Jos F) r 109 Albertus av MO 3805 — Phyllis A stenog Bank of Mont r
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HU 2970 — Rae T tchr Annette St Pub Schl r 173 Geoffrey LO 4514
■ — Ralph h 45 Millicent LO 7288 (act ser) - — -Rebecca Mrs h 42
Glenhurst av (Oak) LL 5206 — Rebecca F stenog State Farm Mutual
Auto Ins Co h 3, 50 St Nicholas — Refrigeration (Wm J A Marshall)
1880 Yonge HU 8073 — Reg r 6 Harvard av LA 1337 — Reta h 22,
80-84 St Clair av w HU 2084 — Rhoda r 439 Sherbourne MI 8474 —
Richd (Marshall Specialty) h 36 Larkin av (Swan) JU 8721 - — Richd
mach Schlegel Co h 534 Runnymede rd LY 8024 — Richd D brklyr r
534 Runnymede rd LY 8024 — Richd H baler Telfer Paper Box r 186
Robina av (Oak) LO 6756 —Rita elk Bell Tel r 25 Slade av LA 9779 —
-Rita wtrs Woolworths r 151 Bingham av — Robt r 264 Ashdale av
(act ser) — Robt r 46 Cayuga av (Mt D) LY 0009 (act ser) — Robt r
163 Woodycrest av (E Y) — Robt asst bkpr Thos Meredith & Co r 7
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46 Sammon av (E Y) — Robt const Stn 2 h 80 Hastings av HA 2753
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Wks h 378 Montrose av LO 6519 - — -Robt emp Fire Dept h 119
Clinton ME 4378 - — Robt emp Imp Varnish r 1254A Danforth av —
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porter Heintzman Co h 55 Humberside av JU 4058 — Robt J pres
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Co Ltd r 44 Coleridge av (E Y) - — Rose (wid Albt) h 112 Rhodes av
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Follis av KE 3580 — Russell storeroom kpr Simpsons r 171 Mutual —
Ruth (wid Chas) r 52 Millicent LO 6749 — Ruth H stenog r 642
Beresford av (Rnny) LY 3643 — S emp Gutta Percha h 33 Grenadier
rd KE 0670 — S store kpr Lincoln Elect r 245 Melrose av — Sarah r
406 Roxton rd LO 6033 — Sarah (wid Donald) h 98 Somerset av KE
7137 — Sarah J (wid Kenric) h 106 Pinecrest rd JU 9853 — Sherman
D mech Long Branch Garage h 1457 Lake Shore rd (Long B) —
Sidney h 145 Lippincott KI 0070 Marshall Sidney T elk CN Exp h 98
Pendrilh LO 2686 — Specialty (Richd Marshall) wire displays 62
Fraser av LO 9685 — Stanley emp John Inglis h 999 College LA 1483
— Stanley A genl mgr Toronto Sanitary Towel Supply Co h 50
Melrose av HU 3826 — Stanley H bkr h 153 Caledonia rd KE 2548 —
Steven btehr Swifts h 12 Bicknell av (Silv) — Susan (wid John) h 114
Chester av HA 6394 — Sydney r 539 Wellington w — T Frank stock
trdr J L Goad & Co r 9 Douglas dr MI 9787 — Thelma r 590 Indian gr
JU 7627 — Thelma opr Derrett Ltd r 168 Harvey av — Thelma with
Tor Hydro r 840 Broadview av — Theodore D order elk Terminal
Warehouses r 28 Corbett av — Thos h 145 Dovercourt rd LA 0323 —
Thos ftr Modern Tool Wks r 1604 Dufferln — Thos janitor CNR r 3
Carlton EL 2583 —Thos jwlr 229 Brock av h same ME 7763 — Thos
transportation adviser Board of Trade h 9 Douglas dr MI 9787 —
Thos trkr CNR Frt h 48 Holly av MO 1937 — Thos A slsmn h 176
Rosewell av MO 5191 — Thos A confy and tob 3526 Eglinton av w
(Mt D) r 3524 same JU 2878 — Thos A slsmn F S Bridges Ltd r 2,
138 Wellesley av — Thos E welder CGE h 294 Rhodes av — Thos G
contr h 31 Talbot — Thos G emp Aluminum Co of Can r 143
Westmount av (Oak) LO 1098 — Thos H elk Grinnell Co h 16 Waller
av (Swan) LY 6795 — Thos H lay-insp Dept of Agric (Dom) Health of
Animals Br h 58 Westmount av LL 7859 — Thos J firemn Tor Pub Lib
h 3, 349 St Clair av w MI 2854 — Thos P elk Eatons h 1846 Bloor w
JU 3907 — Thos R dentist 1112, 62-76 Richmond w WA 4400 h 97
Edgewood av HO 1309 — Thos W r 229 Brock av ME 7763 (act ser)
— Tom gro 957 Mt Pleasant rd MO 4520 h 180 Erskine av —
Valentine M r 203, 35 Raglan av (Wych) LO 2557 (act ser) —
Ventilated Mattress Co Ltd, H P Parker genl mgr of Tor br, mattress
mfrs Eglinton av e at Laird dr (Leas) MA 4418 — Vera r 922
Palmerston av — Verna radio tubes Radio Valve Co r 69 Dunfield av
HY 6901 — W Allen slsmn Chateau-Gai Wines h 307 Sheldrake blvd
HO 5529 — W G engnr John Inglis h 54 Madisoft av KI 1367 — W J
& Co (W J Marshall) stock brkrs 609, 68 Yonge AD 8066 — -W R
mach John Inglis r 54 Madison av KI 1367 — Wallace A h 22 Watson
av (H Crest) LY 4862 (act ser) — Walter h 13 Macaulay av — Walter
G ftr W Crawfords h 840 Broadview av GE 6426 — Walter M carp P 0
h 104 Brookside av (H Crest) LY 2783 — Wilfred r 558 Jane (H Crest)
LY 8532 (act ser) — Wilfred emp De Havilland Aircraft r 36
Montgomery av MO 2490 — Wilfred B slsmn W J Marshall & Co h 24,
2393 Queen e — Wm r 114 Chester av HA 6394 (act ser) — Wm h
236 Dewhurst blvd n (E Y) GE 2172 — Wm r 28 Eaton av GL 6551
(act ser) — Wm h 106, 110 Tyndall av LL 7228 (act ser) — Wm
brklyr h 196 Woodfield rd HA 5201 — Wm caretkr Runnymede Lawn
Bowling Club h 22 Weatherell JU 0328 — Wm dnr Union Stn h 101
Gladstone av LL 5487 — Wm drvr Acme Farmers Dairy h 1320 Pape
av (E Y) — Wm emp CNR h 662 Rhodes av GL 4770 — Wm emp
Dunlop Tire h 46 Dewhurst blvd HA 4379 — Wm elk Hendrie & Co h
64 Glebemount av GR 2733 — Wm genl supt Hendrie & Co h 64
Glebemount av GR 2733 — Wm gro 150 Shaw ME 9493 r 165 same
LA 6594 — Wm insp Dept of Wks h 33 Hallam LO 1396 — Wm insp
Dom Bridge r 71 Lanark av (Frbk) KE 7658 — Wm lab CGE h 257
Mutual — Wm litho h 48 Wanda rd LL 7152 — Wm radio mech h 135
King Edward av (E Y) — Wm shpr R Hedley Shoe r 71 Lanark av —
Wm tool mkr h 183 Mortimer av (E Y) — Wm A emp Dom Bridge h
149 Robina av (Oak) LA 7473 — Wm A mfrs agt 180 Duke r 78
Roxborough c — Wm A pntr and dec Sylvester Mann h 61 Earlscourt
av LL 3703 — Wm A slsmn Neilsons h 280 Margueretta LO 0079 —
Wm A shoe opr Robert Shoe Co h 25 Harcourt avenue — Wm A wldr
h 78 McKenzie cres — Wm A S r 495 Mossom rd (H Crest) LY 4537
(act ser) — Wm C firemn CPR h 590 Indian gr JU 7627 — Wm C
officer WPTB r 212 Dundas e — Wm D h 154 Gillard av GL 1038 —
Wm E elk Royal Bank (Tor Br) h 162 Dunn av LA 5031 — Wm E emp
Christie Brown h (rear) 289 Christie KE 1625 Marshall Wm E engnr
Can Malting h 36 Glebemount av HO 6684 — Wm E shpr Geo H
Hees h 83 Kane av (Silv) — Wm F emp Natl Club r 55 Glen rd — Wm
F plmbr Purdy & Mansell h 210 Cedric av (Frbk) ME 1424 — Wm H b
237 Hiawatha rd — Wm H (Marshall Hardware) h 12 Glenholme av
LL 8705 — Wm H elk Aluminum Co of Can h 237 Franklin av LL 8403
— Wm J carp h 598 Crawford LO 7648 — Wm J elev opr Lumsden
Bldg h 474 Windermere av LY 0462 — Wm J toolmkr Duplatc Tool
and Die h 1599 Dufferin LL 9186 — Wm J A (Marshall's
Refrigeration) h 105 Donegall dr (Leas) HY 0640 — Wm J T toolmkr
Bury Engnrg h 719 Millwood rd (Leas) HU 2322 — Wm M h 80
Kenwood av (Wych) LA 7001 — Wm R dentist 3, 1041 Avenue rd n
HY 1038 h 125 Lawton blvd HY 2073 — Wm R trnmn CPR h 24
Waller av (Swan) JU 9932 — Wm T slsmn Commercial Life Assce h
52 Beaty av LA 9739 — Winnie Mrs r 348 George RA 4325 —
Winnifred Mrs wtrs Eatons r 348 George — Winnifred A elk East York
Twp r 30 Connor av (East York) — Zella mlnr Simpsons r 410 Quebec
av MU 1236 Marshall's (Benj Berg) Ids wear 2850 Dundas w LY 8658
and 535 8ayview av (Leas) MA 4352 — Co Ltd Lome P Marshall pres
and mgr Percy Lobley sec-treas produce (whol) 68 Front e WA 2721
— Delicatessen (Wilfred Smith) 828 Danforth av HA 0777 — Drug
Stores (Arthur C Marshall) 310 Queen e WA 2121, 542 Queen w EL
0055 and 412 Summerhill av RA 2222 Marsham Joan r 202, 2932
Yonge MO 2603 (act ser) Marshell Victor L slsmn Acme Farmers
Dairy h 34 Ronald av (Frbk) LL 3898 Marshfield Fredk mgr New
Toronto Billiard Parlor h 84 Fourth (New T ph 217) Marshin Jos cabt
mkr h 450 Victoria Park av GR 5709 Marshman Austin Rev asst priest
St Brigid's (RC) Church r 300 Wolverleigh blvd GR 3414 — -Benj J h
50 Eversfield rd (Frbk) — Edwd shpr Ault & Wiborg h 271 V2 Bartlett
av ME 0649 — Edwd F plmbr Carter & Hall h 254 Weston rd s JU
1046 —Gerard H I c PO h 30 Tenth (New T) — John r 144 Caledonia
rd KE 5091 (act ser) — John B emp Loblaws h 196A Brock av LL
5955 — Jos r 60 Auburn av LO 5183 — Jos M mech Candn Acme
Screw & Gear h 347 Osier LY 4391 - — Mary mgrs Federal System of
Bakeries h 144 Caledonia rd RE 5091 — Patk maintenancemn Candn
Acme Screw & Gear h 223 Oakwood av (Oak) ME 3335 — Thos J r
144 Caledonia rd KE 5091 Marshment Alec r 9, 85 Beech av HO 3909
(act ser) — Ellen Mrs wtrs Bank of Com (Hd Off) r 63 Alexander —
Ethelyn (Floral Art Studios) r 6, 280 Wood' field rd — Percival L
Idgrkpr Prov Savings Office (Danforth and Fenwick) h 405, 317
Sherbourne Marsich Dusan metal mn Alexander's Body & Motor
Service r 2804 Dundas w LL 6510 — Steven emp Massey Harris h
2804 Dundas w LY 6510 ♦Marskell, see also Maskell - — Gordon
drftsmn Cansfield Elect Wks r 81 Crawford EL 3570 — John G shpr
Tor Hardware h 81 Crawford EL 3570 — Jos r 12 Briggs (act ser) —
Louis drvr Colville Cartage h 255 Waverley road — Regd r 81
Crawford EL 3570 (act ser) Marsley Ada Mrs h 191 Coleridge av (E Y)
GR 9902 Marsolias Fredk opr Imp Varnish h 92 Maitland MI 5705
Marson Albt die caster Newberg Die Casting Co r 455 Dundas w —
Alfred emp REL h 109 Briar Hill av HY 2968 — Chas A emp REL h 88
Castlefield av — Doreen M elk Lever 8ros r 42 Apple Grove avenue
— Doris prsr Wm Gluckin & Co r 455 Dundas w — Edwd G emp
Silverwoods Dairy h 5Vz Railton cres MO 9298 — Evelyn bkpr
Ordnance Corps r 34 Craighurst av MO 1283 — Fred (Harris &
Marson) h 237 Evelyn av LY 3605 — Jas die caster Newburg Die
Casting Co r 455 Dundas w — Mary Mrs r 34 Craighurst av MO 1283
— Robt brklyr A P Green Fire Brick h 182 Woburn av HU 1283 —
Robt A h 455 Dundas w Alphabetical, White Page 855
 MAR MARSON Marson Robt J attdt Super Motor Sales r 182
Woburn av HU 1283 — -Wm D quarantine insp Dept Pub Health h 42
Apple Grove av GE 5398 - — Wm H mech City Playgrounds h 143
Gough av HA 5085 Marster Lorraine r 503 Dupont LA 5644 Marstoky
Gordon h 254 Markham RA 1826 Marston A Jas druggist Hoopers
Drug Store h C5, 18 Elm Grove av LA 2752 — Albt E carp Eatons h
52 Hazelwood av HA 9281 — Clara L (wd W G) h 58 Lake Shore blvd
LA 1341 - — Dorothy social wkr Dept Pub Welfare r 58 Lake Shore
blvd LA 1341 — Fredk h 151 Hastings av — John J lathe hand Jas
Morrison Brass h 36 Eastdale av (E Y) — Lillian hlpr Safety Supply r
151 Hastings av — Rachel B (wid Harold) r C5, 18 Elm Grove av LA
2752 — Stanley shpr Geo M Watson & Co h 730 Spadina av MI 3948
Marstrand Vera emp Genl Engnrg h 213, 1-5 Homewood av
Marszalek John emp Can Packers r 414 Symington avenue — Walter
assmblr Sutton-Horsley r 47 Alexander Mart Annie (wid Jas) h 618
Manning av ME 3241 Martarine Anthony wrehse elk Cook Clothing r
274 Berkeley Martarino James h 38 Sproat av GL 6154 (act ser) —
Jas fruit pdlr h 274 Berkeley —Sarah emp Cook Clothing r 274
Berkeley Martel A Mrs opr Genl Engnrg h 4, 1169 Danforth av —
Adelard emp CNR h 64 Main (Mim) — Geo emp r 52 Grant — Jos elk
G Aime Trudeau h 132 Queen e WA 8135 - — Jos tool mkr Leeds
Steel Products r 261 Airdrie rd (Leas) — Lawrence J mldr Dorn
Abrasive Wheel r 64 Main (Mim) — Lorenzo J elk P 0 h 68 Rosethorn
av —Luke shaper hd J & J Taylor r 565 Richmond w Martell Arthur r
130 St David WA 4307 — Edwd mach Sutton-Horsley h 235 Leslie
HA 2871 — Elzear shpg elk Upjohn Co h 114 Douglas av M0 2375 —
Wilfred shpr Can Metal r 76 Winnifred av - — Wm trk drvr hlpr
Burfords Transport r 44 River EL 0618 Martelle Berenice h 4, 247
Gladstone av LA 7678 — Norman J paint mixer CIL h 5 Humber blvd
(Mt D) Martelli Ernesto lab CGE Royce Av Wks r 5 Beaver av Martello
Albt emp John Martello & Sons Ltd r 16 Strathearn rd (Cedarvale) HY
2859 — Alfred G (John Martello & Sons) res Peterboro — John &
Sons (Alfred G Martello) contrs 16 Strathearn rd (Cedarvale) HY
2859 — Mary (wid John) h 16 Strathearn rd HY 2859 Marten
Beatrice E elk Dept of Agric (Ont) r 7 Dixon av - — Chas B wldr
Armstrong Machine r 56 Winnett av (Wych) KE 8436 — Howard A r
72 Stibbard av HU 2377 — Margt A nurse Tor Western Hosp r 72
Stibbard av HU 2377 — Muriel E (wid Chas) h 7 Dixon av HO 9283 —
Rod W 0 elect Genl Theatre Supply r 72 Stibbard av HU 2377 - — T
Alan r 72 Stibbard av HU 2377 (act ser) — Thos 0 comm artist h 72
Stibbard av HU 2377 — Wm A bus drvr TTC r 90 Alcina av LA 3113
— Wm J with Bell Tel r 1115 Glen Grove av (North York) — Winifred
M elk City Treas r 72 Stibbard av HU 2377 Martens A J slsmn
Surgical Supplies res Port Credit — Arthur photo engnr Rapid Grip &
Batten h 33 Lakeside av (Bch C) — Arthur plmbr 38 Lakeside av (Bch
C) h same HO 5274 — Betty slsdk Eatons r 232 ,Ashworth av —
Henrietta opr Metal Stampings r 38 Lakeside av (Bch C) HO 5274 —
Henry A toolmkr Link-Belt h 22 Athletic av HA 2441 — Olga stenog
Harold V Venning r 22 Athletic av HA 2441 Martenuik John r 71
Woseley WA 0189 Marter Arthur L slsmn H J Heinz Co h 247
Roehampton av HU 9334 — Carlton C bkpr Morley & Son r 203
Strathmore blvd HA 8513 — Claire stenog Industrial Acceptance
Corp r 247 Roehampton av HU 9334 — Fredk W r 142 Springhurst
av LA 0783 • — Jessie G (wid Edwd) h 275 Strathmore blvd HA 0970
—Percy H lab Dept of Wks h 24 Drayton av — Regd H elk h 203
Strathmore blvd HA 8513 Marth Alex pntr Candn Scale h 336 Robina
av (Frbk) LL 0306 Martha Lansen (Martha A Woschitz) dress shop
3215 Yonge MO 6485 Martha's Dress Shoppe (Martha Dusza) 827
Queen w EL 3687 Martial Francois porter King Edward Hotel r 362
Dundas e MI 9592 ^Martin, see also Martyn — A Alvin phy and surg
992 Woodbine av h same GR 5097 — A J despatcher Labatts
Brewery h 31 Kenilworth av HO 5424 — A Louis candy mkr Brownies
Chocolates h 239 Rosethorn av (Silv) — A Maude sec Moloney Elect
Co of Can h 301, 110 Wellesley RA 3471 — A P wrehsemn Natl Drug
r 23 Dunkirk rd — A Stanley engnr Robt Amell & Co r 761 Pape
avenue — Ada M h 74 Highcroft rd GR 1803 — Ada M emp Edison
Lamps r 94 Humber blvd (Mt D) LY 0784 — Adelaide Mrs r 106
Dinnick cres HY 0721 — Adele (wid Wm) r 14 McRoberts av KE 9117
— Agnes Mrs r 73 Benson av — Agnes Mrs r 664 Pape av — Agnes
Mrs counter girl Muirheads h 132 Douglas av MA 5215 — Agnes (wid
Andrew) h 1131 Dufferin LL 8961 — Agnes (wid David) h 27V2 Lewis
- — Agnes (wid Edwd) h 105 Old Forest Hill rd (Fst H) MA 2585 —
Agnes (wid Hugh) h 384 Whitmore av (Frbk) LL 0194 — Agnes (wid
John A) h 499 Armadale av LY 1436 - — Alan R engr Brigdens h 312
Jane JU 2704 — Albt r 45 Gloucester KI 8183 — Albt h 78
Newmarket av GR 8994 (act ser) — Albt emp John Inglis h 509, 262
Jarvis - — Albt prntr Globe and Mail h 358 Brock av LL 7019 — Albt
research asst Moffats Ltd r 55 Greendale avenue — Albt D r 6 Bain
av GL 4089 — Albt E barber r 65 Lewis — Albt E cook CNR h 4 Ashby
pi — Albt E wtr Winchester Hotel h 43 Somerset av ME 6420 — Albt
G A asst div supt motor traffic TTC h 497 Carlaw av GL 3350 — Albt
P prsfdr Thompson Folding Paper Box r 106 Pembroke av - — -Albt S
shade opr Fred G Soper & Co h 422 Wellesley MI 6889 - — Alex r 40
Greenwood av —Alex r 205 Seaton RA 3715 - — Alex elk Northern
Elect h 309, 1560 Bathurst (Wych) LA 4842 — Alex emp CGE r 390
McRoberts av (Frbk) — Alex engnr Ont Hosp h 68 Northcote av LA
8743 - — -Alex lab Massey Harris h 260 Delaware av —Alex mech
Lever Bros r 16 Shortt (Frbk) —Alex B staty engnr Can Packers h 126
Wright avenue - — Alex R mgr Imp Bank (Tor Br) h 54 Poplar Plains
rd MI 4420 — Alex S slsmn A R Clarke h 58 Baby Point rd (H Crest)
LY 4801 — Alex T barber 1182V2 Queen e h 686 Adelaide west —
Alfred h 430 Merton — Alfred staty engnr h 396 Mortimer av (E Y)
GE 4932 — Alfred stockrm elk Riverdale Garage h 574 Greenwood av
—Alfred C moto TTC h 23 McRoberts av KE 7171 — Alfred G carp Tor
Harbour Commn h 16 McRoberts av KE 5909 — Alfred W h 493
Clendenan av JU 5529 — Alice Mrs r 70 Main (Mim) ph N T 207W —
Alice (wid Fred) h 915 Carlaw av HA 2375 — Alice (wid Jas R) r 84
Alcina av LA 3903 - — Alice (wid Wm) r 34 Virginia av (E Y) HO 8412
— Alice (wid Wm R) cigars and tob 934 Queen w ME 0240 h 4198
Dundas w (La M) LY 7240 —Alice I stenog Western Assce r 3, 348
Spadina road - — Alice L bkpr Merchants Credit Coll r 139 Chisholm
av (E Y) — Alice L elk Wm R Martin Jr r 4198 Dundas w (La M) LY
7240 - — Alice R tchr Oakridge Pub Schl r 131 Westlake av GR 3923
— Allan G appr Candn Appraisal Co Ltd h 292 Vaughan rd (Wych) LL
6674 — Allan G jr photostat opr Shell Oil r 292 Vaughan rd (Wych)
LL 6674 — Allen E treas Strathdie Transport Ltd r 201 Cortleigh blvd
HU 3712 — Alma traffic elk Eatons r 34 Tennis cres GL 3062 — Alma
A bkpr Patterson Electric Ltd r 50 St Clarens av ME 2831 - — Alvey J
h 72 Lincoln av LY 1515 - — Alvin r 53 Maitland KI 0516 - — Alwyn
elk Eatons r 18 Elm - — -Amelia (wid Donald M) h 102A Pricefield rd
— Amy opr Hamilton Carhartt Mfg r 111 Amelia — Amy B stenog
Candn Telephones & Supplies h 110, 2707 Yonge MO 7812 —
Andrew h 29 Hanson rd (Frbk) — Andrew h 78 Simpson av HA 5483
(act ser) — Andrew B mail porter P 0 r 117 Curzon - — Andrew G
emp Candn Kodak h 21 Seneca av (Mount Dennis) — Andrew H shpr
Victoria Paper & Twine h 10 Hounslow Heath rd LY 9530 — Andrew P
elk Natl Drug r 23 Dunkirk rd (E Y) GR 5309 — Andrew P mach John
Inglis Co h 4, 2269 Queen e HO 7425 — Andrew R asst mgr Eatons
h 383 Armadale av LY 2341 — Andrew S elk Eatons h 4, 114
Vaughan rd (Wych) LA 0419 — -Angelo lab r 40 Royce av LO 4591 —
Angus emp Colgate-Palmolive-Peet h 300 Pape avenue — Angus
foremn L S Tarshis & Sons h 616 Soudan av HY 8479 Martin Anita N
S elk Bank of Com (Hd Off) r 14 McMaster av MI 5731 - — Ann Mrs
emp Natl Cash Register r 15 Howard Pk av KE 7690 — Anna tchr St
Joseph's Schl r 3 Doel av HA 1567 — -Anna H (Adelyne Frock
Shoppe) h 602 Bloor w ME 7100 - — Anna M elk Moffats Ltd r 110
Williams (Wstn) — Anne elk Tor Fuels r ZlVz Lewis — Annie emp Geo
H Hees r 50 Shudell av HA 3769 - — Annie (wid Wm) r 142
MacPherson KI 3318 —Annie B (wid Robt) h 11 Roxborough w MI
9284 — Annie J (wid W H) h 55 Wineva av HO 0968 - — Annie M
(wid Herbt S) h 13 Earnbridge ME 6233 • — Anthony baker
Simpsons r 125 Fairlawn av — Aresta A J slsldy Simpsons r 603V2
Parliament RA 4047 — Arlene emp G A Martin r 69 Regal rd KE 4045
— Armien J opr Gair Co r 127 Nairn av LL 1489 — Arnold lab Gen
Steel Wares r 241 Seaton — Arthur (Martin Furs) h 544 Winona dr
(Frbk) — Arthur (Martin's Service Stn) h 267 Atlas av (Cedarvale), KE
5788 — Arthur attdt Willie Martin Serv Stn r 390 Manning av MI
8389 — Arthur foremn Cont Can Co h 157 Fern av LL 9064 — Arthur
pekr Eatons h 71 Holly HY 2921 — Arthur uphol Massey h 121 Cedric
av (Frbk) ME 5296 — Arthur D pressmn Bps System h 315 Ashdale
avenue — Arthur F rubber wkr Dunlop Tire h 313 Sackvi lie WA 1315
— Arthur G wldr Gen Steel Wares h 135 Oakcrest avenue — Arthur G
r 65 Peterboro av ME 7609 (act ser) — Arthur H frmn Can Wire &
Cable h 256 Airdrie rd (Leas) MA 3857 — Arthur H C slsmn CGE h 62
Elmer av HO 2941 — Arthur H S asst dir Agr Reps Branch Dept of
Agric (Ont) h 6 Wanless cres HU 7163 — Arthur J h 208, 2707 Yonge
MO 6903 (act ser) — Arthur J app CCM res Port Credit — Arthur J sis
elk Eatons h 23 Minton pi (E Y) - — Arthur N archt T Pringle & Son
Ltd res’ Willowdale — Arthur W steward h 972 Eastern av — Asa M
trk drvr RCAF No 1 Depot h 1, 277 Berkeley — Aubrey M r 16
McRoberts av KE 5909 (act service) — Audette emp Union Station r
482 Logan av — Audrey r 50 St Clarens av ME 2831 - — -Audrey h
412A Summerhill av — Audrey B tchr Tor Cons of Music r 64
Rusholme rd LO 7329 — Austin J opr Candn Kodak h 26 St John's rd
(Wstn) — B Jean emp Bell Tel r 119 Oakwood av LL 3421 - —
Barbara Idgrkpr Dorn Bank (1443 Yonge) r 74 Garfield av — Beatrice
h 29 Hewitt av ME 0634 — Belle elk Ont Hydro 305, 77 Wellesley KI
8856 — Benj h 183 Eglinton av e MO 8143 — Benj jr r 183 Eglinton
av e MO 8143 (act service) — Benj r 260 Waverley rd HO 1275 —
Benj E sec Rock Realty & Investments Ltd h 260 Waverley rd HO
1275 — Benj F elk PO h 202 Merton — Bernard H h 71 Forman av
HY 6429 — Bernard J timekpr O'Keefe's Brewing h 111 Brooke av
(Nth Y) HU 5942 — Bernard W hlpr CCM r 50 Greendale av (Mt D) -
— Bernice V sis elk Simpsons r 71 Forman av HY 6429 — Bert B
guard Dorn Bridge h 58 Kennedy av (Swan) JU 4844 — Bert T elk
Gutta Percha h 12 Marshall blvd (Mt D) — Bertha h 320 Carlton —
Bertha (wid C H) h 424 Sackville MI 8917 — Bertha E statistics Wm
Wrigley Jr r 131 Westlake av GR 3923 — Beryl M mus tchr h 25
Cortland av HU 8722 — Bessie Mrs h 437 Gladstone av KE 7091 —
Bessie A Mrs h 8 Twenty-Seventh (Long B) — -Bessie N (wid Irwin)
stenog Dept of Agric (Ont) h 20 Ridley Gdns LA 6214 — Bette stenog
Mont Trust r 79 Furnival av (E Y) — Betty elk Natl War Service Bd r
225 Grenadier rd LO 4515 —Betty slsldy Eatons r 232 Ashworth av
ME 6626 —Betty A r 58 Baby Pt rd (H Crest) LY 4801 — Betty L opr
Index Card Co r 100 Berkshire av — Beulah mech Underwood-Elliott-
Fisher r 18 Foxbar av — Blanche ironer Langley's r 121 Day av —
Braithet W tax coll Swansea Municipal Off h 94 Runnymede rd
(Swan) — Bros (Harold F & Eugene H Martin) ships supplies 26 Front
e AD 3577 — Bros (Kemmis B & Terence B Martin) oil heating &
conditioning 152 King w WA 3893-4 - — Bruce emp Crawford
Cartage Co r 217 Riverdale av GL 0708 — Bruce S mach Small
Electric Motors h 200 Lawrence av w — Builders Ltd Wm H Martin
pres & mgr contrs & bldrs 28 Harcourt av HA 4143 — C emp Can
Packers r 4 Greendale av (Mt D) — C Jean (wid Wm) r 328 Durie LY
2274 - — C K Craufurd asst gen counsel (Gooderham, Martin & Co)
Mnfrs Life h 37 Whitney av KI 2725 — Carman cost elk Rogers-
Majestic h 42 Lakeview av — Carmen H (wid Henry) prac nurse r 6,
3 Vermont av LA 6670 Martin Caroline (wid Sami) h ( JU 9542 —
Cartage Ice & Fuel (John R GL 2108 - — Catharine bench wkr W & j
Kimberley av — Catherine (wid Patrick) r 367 MA 1289 — Cecil h A,
559 King w (act sa - — Cecil B elk Rapid Grip & Batten, —Cecil F asst
shipper Drug Tradint ' east — Cecil V mach Can Wire & Cafe , - —
Cecil W elk A D Gorrie & Co j — Cecil W shpr Christie Brown h —
Cecilia (wid Percy) r 449 Ashd | — Cedric motor mech Daily Star LO
4164 - — Cedric K mech Star r 444 Sherbc — Chas h 312 Cosburn av
(E Y) service) — Chas h 103 Coxwell av HO 20 — Chas r 437
Gladstone av KE 70 — Chas r 15 Thornhill av (H Cre — Chas acting
det Stn 8 r 633 ( — Chas emp John Stewart h 10, 92i - — Chas
engnr Laidlavrts h 38 Keel; — Chas lab CNR r 46 Macpherson —
Chas millmn Goodyear Tire h 4 LY 3368 — Chas wtr Royal York Hotel
h 3, RA 5813 — Chas A (Weston Hotel) h 370 ph 825) — Chas A
carp Kirbys Jobbing Co I av (Mt D) JU 5976 — Chas B comm artist r
76 Horn 4881 - — Chas E pntr & dec r C, 73 Trille — Chas E loader
Tiverton Transport stone av (Frbk) — Chas E stkpr Gas Co r 837
Gem ; — Chas F pntr Shell Oil h 8 Bat — Chas G h 100 Gloucester
MI 1( — Chas H formn Anaconda Amer Fifth (New T ph 1573) —
Chas J det City Police h 406 S GR 8906 — Chas L drvr h 97
Dunlngton dr — Chas L opr TTC h 60 Afton ar — Chas L trk drvr
White Linen Supp — Chas M service mgr Farr & So; (Wstn ph 448)
— Chas P h 59 Kimberley — Chas S barr CGE h 106 Dinnick — Chas
W fire chief Massey-Harris mede rd (Swan) LY 5977 — Chas W insp
Dept Pub Health i e AD 9868 — Chas W emp Thompson Folding 185
Seaton - — Charlotta (wid Geo) h 97 Balsan - — Charlotte (wid Edwd
G) r 1, 466 — Chester Prof head of dept U of ' h 24 Hawthorne av
RA 4253 — Chris A mgr United Cigar Stor h 686 Adelaide w —
Christina h 44 Alvin av HY 515 — Christina W h 121 Cedric av (Fi —
Christine emp John Inglis r 2; 9262 — Christopher B lab Cement
Block av (E Y) GL 1291 - — Cissie Mrs vrirs Eatons - — Clara h 55
Indian Trail LL 19 - — Clara Mrs sis Idy Mrs Kate Dan - — Clara (wid
Robt) h 278 Evelyn av — Clara B (wid Chas) insp Candn v Gear h
304, 18 Tichester rd — Clara J forelady Sellers-Gough h (Nth Y) HU
4929 — Clarence mech McBride's Garage strong av ME 6655 —
Clarence stmftr hlpr Eatons h 5i - — Clarence H emp Bell Tel h 11 LL
3421 — Clarence H opr Candn WirebouK Marjory av — Clarence W
photo engrvr Photo E> Cranbrooke av MO 4809 — Claude h 173
Macdonell av LO t — Claude elk Drug Trading h 521 3307 — Claude
W r 123 Blythwood rd M( — Cleason clnr TTC r 24 Alcina a» —
Clifford W (Danforth Book Shop) forth av HA 9809 — Clifford W asst
constrn supt Woe Playter cres GE 6834 — Clifford W route slsmn
Borden Maples Bain av — Clifton h 571 Euclid av ME 6947 — Clinton
R W glue mixer Gair Co av ME 6765 — Clonda Ithr wkr Tourist
Supply (E Y) — Constance mus tchr h 169 Heath - — Constance E
emp John Inglis r 2327 — Cora B Mrs h 60 Silver Birch 2 — Cosgrove
E pntr & dec r 129 Shan — Cyril reevr Can Packers h 55 (Mt D) LY
7110 — David h 1062 Queen e —David carp RCE h 411 Main (E 1 —
David emp REL h 62 Shudell a> — David ftr ‘ Matthews Bros h 26i
(Oak) — -David hlpr Hardy Ctge r 77 HA 5184 — David mail prtr P 0
h 172 Gs GR 1549 — David A h 91 Cordelia av (Mt (act ser) — David
B opr Candn Liquid Air h av (La M) JU 7930 — David D gen sis mgr
Momo Ltd h (Leas) MO 9390 —856—
 rep CP Exp h 64 Rusholme Z N Exp h 58 Olive av LA - dept
CPR h 2 Minton pi 2 assy Hotel h 237 Bleecker /en rd (act ser)
•pincott (act ser) rnth (New T ph 1941R) 'ool Repair r 1256
Woodbine Ont Hydro h A 408 Bayview tjax Repair & Constn h 331
.ife r 25 Cortland HU 8722 6, 61 Maxwell av MO 6362 Hose av LO
0648 -own h 4, IIOV2 Queen e eel Wares r 55 Ferrier av itons r 60
Wembly rd x Repair Constn r 34 New258 Alvin av HY 3218 p
Strachan Schl r same Controllers Off r 202 Merton Woolworths r 48
Essex Harris, Keachie, Torrance & louglas av Della MI 2681 stlake av
(E Y) (act ser) Bridge h 214 Springdale 0590 leilson's r 187 Westlake
av tark Elect Instrument r 260 1275 Perm Trust res York Mills Link-
Belt r 22 Billings av c Ont Research Foundation r <1 5471 Oil r 95
Balsam av ’oplar Plains cres MI 1209 lept Telegram r 78 Spruce nally
av MI 2659 5 Erskine av MO 4435 mdn Credit Men's Trust Assn .!
7568 lal r 11 Forsyth rd MA 1913 Tea h 63 Gowan av (E Y) ron
Fireman h 581 Dufferin r Vale & Sheppards h 302 Pkwy HY 8578 lyn
av LY 7877 (act ser) :ourt av HA 4143 (act ser) Eatons r 279 St
Helens av ns r 552 Glebeholme blvd Small Arms h 23 Victor av 418W
Jonald Mfg r 298 Boon av Monarch Park av GL 3419 Can Life h 45
Maxwell av ton Bros h 201 Cortleigh asant blvd RA 2830 av GL 2644
Carbonic Candn Corp h 120 )543 con Transport h 1A, 134 wndr
Sangamo Elect h 373 I College alisher Simpsons h 33 Lucy '-Harris
Co h 28 MacLean 7496 Arcadian Theatre h 38, 414 Coxwell av (E Y)
h 1252 Engnrng h 1, 162 Glen rd h 146 Livingstone av (Frbk) n Tool
Wks r 183 Eglinton 506 Soudan av MO 2655 Electric r 19 Kingswood
rd ock av LY 8374 (act ser) lall Arms r 586 Gladstone av Vellesley KI
1888 andn Co r 69 Wrenson rd -treas Tomenson, Saunders, -td r 328
Lauder av (Oak) Eatons r 19 Bel lefair av :ll L Martin (Cleve) pres,
vice-pres & mgr, Theresa fleet apparatus & hairdrsrs 8821 bane KI
9556 Td av ME 7970 r 264 Strathmore blvd !Ck Schl r 585 Church
iastwood av (Bch C) ’P for Sick Children h D8, h 38 Hastings av clnr
Stewart Bldg h 46 29 h 36 Lauder av LL 2880 L) h 4, 9 Benlamond
av 3, 310 Brunswick av 452 Westmoreland av LO Martin Elizth S h
100 Pembroke MI 6711 — Ella h 149 Redpath av MO 4910 — Ella
Mrs assorter Crown Cork & Seal r 56 Eldon av — Ella (wid David) h
4, 33 Lee av GR 2234 — Ella N lecturer Royal Ont Museum r 84
Queen's Park — 'Ellen bindery Eatons r 915 Carlaw av — Ellen proc
lab Candn Natl Carbon r 69 Cecil AO 2644 — Ellsworth h 673 Shaw
LA 4676 (act ser) — Elmer E emp Moffats Ltd r Wadsworth cres
(Wstn) — Elmer R trk drvr Active Cartage h 237 Leslie GL 5085 —
Elmore E elk Bank of Com (156 Pearl) h 15 Barrie av (Oak) ME 3735
— Elsie elk L K Liggett Co r 34 Tennis cres — Elsie Mrs hrdrsr Isobel
McArthur r 231 Fern av — Elsie A r 229 Church (Wstn) — Elva emp
John Inglis h 25 Lapp (Mt D) LY 0337 — Elva emp United Drug r 34
Tennis cres — Elva H hrdrsr r 36 DeForest rd (Swan) — Emily h 118
Hudson dr HY 4038 — Emily Mrs elk Natl Grocers r 146 Montrose av
LO 0004 — Emily (wid Albt) h 67 Bertmount av HA 3662 — Emily A
elk Bond's Bakery r 879 Pape av (E Y) GL 3885 — Emma wrpr
Gilchrist Baking r 257 Milverton blvd — Emma Mrs r 124 Miller av —
Emma (wid Geo) r 402 Milverton blvd GL 1975 — Emmanuel G carp
Phoenix Co h 324 St Germain av MO 8693 — Ermina sis elk
Simpsons r 324 St Germain av MO 8693 — Ernest chemist Sutcliffe &
Bingham h 79 Riverview Gnds (H Crest) JU 2288 — Ernest parcel
boy Pickering Farms r 34 Tennis cres — Ernest emp CNR h 82 Third
(New T) — Ernest genl mgr Sutcliffe & Bingham of Can h 79
Riverview Gdns JU 2288 — Ernest C industrial services 1205, 137
Wellington w AD 7989 h 74 Garfield av HU 6413 — Ernest F
maintenance Natl Life Assce h 75 Hayter — Ernest G bldr h 34
Lawrence av e HU 4537 — Ernest W agt London Life r 68
Westmoreland av LO 2521 — Estella r 75 Awde LL 4714 — Esther
Mrs bushel ler Jos Gould & Sons r 26 Robert — Esther Mrs emp
MacLean Pub h 323 Jones av HA 5683 - — Esther M stenog North
Amer Life r 68 Oakcrest av — Ethel r 817 Pape av GL 3134 — Ethel
tel ad room Telegram r 46 Chester tav GE 6679 — Ethel winder York
Mending Wool r 936A Gerrard e — Ethel (wid Bert) h 144
Westminster av LO 7469 — Ethel D Mrs (Doll's Hospital) h 67
Donlands av (E Y) HA 8807 — Ethel M r 76 Jackman av GE 4679 —
Ethel M elk Adams Furn r 80 Frizzell av — Eugene H (Martin Bros) r
144 Westminster av LO 7469 —Eva h 817 Pape av GL 3134 — -Eva
artist Lambert Studio h 31, 91 Wellesley — Eva (wid Duncan) h 145
Winchester RA 5631 — Eva T (wid Wm) h 7, 17 Jane LY 8976 —
Evan S genl contractor 12-16 Saulter GL 2818 h 100 Neville Park
blvd HO 4105 — Evelyn bkpr Woods Ltd h 81 Queens dr (Wstn ph
861J) — Evelyn Mrs h 52 Hoyle av MA 3121 —Evelyn H r 6 Bain av
GL 4089 — F Earl mgr Cedarvale Tree Experts r 30 Grenview blvd n
(Kngswy Pk) LY 6561 — Fergus L r 60 Silver Birch av GR 9948 (act
service) — Filena r 205 Golfview av — Finlay first air man Hepburn
Co h 40 Westwood av (E Y) — Florence r 34 Lawrence av e HU 4537
— Florence h 14 Newsham LL 7215 — Florence nurse Tor General
Hosp r 509 Huron KI 8224 — Florence Mrs emp John Inglis h 103A
Boon av — Florence Mrs emp John Inglis h 77 Orchard View blvd MO
4065 — Florence Mrs milliner Newport Millinery r 130 Marchmount rd
— Florence (wid Norman) r 37 Spruce — Florence L stenog an Perm
Mort r 4 Indian Valley cres LL 4330 — Florence M emp Dorn Paper
Box r 1501 Gerrard e — Floyd r 68 St Clarens av KE 1320 (act ser) —
Foster r 172 Sherbourne WA 4273 — Frances E r 313 Sackville WA
1315 — Frances E emp Bell Tel h 22 Beatty av — Frances H emp
Norfh The Hatter r 25 Gordon — Francia A elk Dorn Bank (Tor Br) r
292 Kennedy av LY 5656 — Francis insp City Treas h 279 St Helen's
av LL 8670 — Francis J prin elk Dept of Highways h 367 Castlefield
av MA 1289 — Francis N lab Board of Educ h 23 Kent rd GE 3619 —
Frank caretkr Bloor Coll Inst h 12, 2 Salem av LO 0150 — Frank
dentist 918, 170 St George KI 1053 h 95 Edgewood av HO 0415 —
Frank emp John Inglis h 33 Fennings — Frank folder opr MacLean
Pub h 277 Logan av — Frank grinder CGE Royce Av Wks h 14 Brad
— Frank opr andn Kodak h 3 Bala av (Mt D) — Frank plant supt
Sterne Equipment Co h 16 Tyrrell av — Frank press hlpr Dorn Bridge
h 279 Crawford LL 3417 — Frank sis elk Eatons h 641 Mortimer av (E
Y) Martin Frank A h 96 Applegrove av GL 6435 (act ser) — Frank A r
43 Gilbert av KE 3954 (act ser) — Frank B prod dept Natl Steel Car h
644 Runnymede rd LY 4044 — Frank D fitter CGE Royce Av Wks h 18
Wellwood av (Wych) LA 1771 — Frank E mgr Premier Shoe Repair
Shop h 750 Broadview av GE 4495 — Frank H h 1392 Queen e —
Frank H emp Parks Dept h 4, HOMi Queen e WA 4356 — Frank J
buyer Drug Trading h 55 Wineva av HO 0968 — Frank V r 301
George MI 8864 — Frank W crane opr Massey-Harris h 82 Benson
avenue — Frank W shpr Sodean Ltd h 936A Gerrard e — Franklin
sales mgr Kellogg's h 110 William (Wstn ph 912) — Fraser emp
MacLean Pub h 96 Edgewood av GR 1674 — Fred r 30 Weller HO
8796 (act ser) —Fred lab h 397 Sackville MI 2770 — Fred laboratory
asst W Lloyd Woods h 12-13, 225 Sherbourne — Fred slsmn Kelley
Feed & Seed r 231 Melita — Fred D emp Tor Shipbuilding r 473
Woodbine — Fred E slsmn h 3 Buttonwood av (Mt D) JU 2378 —
Fred E wrehsemn Brandram-Henderson h 211 Langley av HA 2429
— Fred G emp John Inglis h 426 Hillsdale av e MO 5547 — 'Fred J
engnr Laidlaw Lumber h 490 Gilbert av (Frbk) KE 1956 — Freda
assmblr Can Motor Products r 8 Napanee — Freda Mrs elk Eatons h
G6, 36 Maitland — Fredk h 109 Caroline av — Fredk Jr r 111 Nairn
av KE 5563 - — Fredk h 109 Russett av — Fredk h 457 Wellesley RA
3418 — Fredk emp Dept St Clng h 267 Perth av LL 6395 — Fredk
firemn Stn 25 h 111 Nairn av KE 5563 — Fredk slsmn Geo Weston
Bread h 5, 1065 Bathurst LA 1809 — ‘Fredk shipbldr h 225 Grenadier
rd LO 4515 — Fredk A steward University Club h 155 Booth av GL
2859 — -Fredk C prod controller Prenco Progress r 4, 9 Benlamond
av GR 6307 — Fredk D receiver Dorn Bridge h 122 Ferrier av —
Fredk G dept mgr Conger Lehigh h 159 Macdonell av ME 1291 —
Fredk G emp John Inglis h 10 Queensdale av (E Y) — Fredk G opr
John Inglis r 869 Runnymede rd (Rnny) JU 0302 — Fredk H pntr
Smith Bros Motor Body Wks h 46 Chester av GE 6679 — Fredk J
cutter Eatons h 368 Victoria Park av HO 7211 —Fredk J orderly
Christie St Hosp h 474 Montrose av — Fredk J traveller h 63
Holborne av (E Y) — Fredk L J r 46 Elm av RA 4074 (act ser) —
Fredk E mech h 23 Winnifred av HA 2395 — Fredk T fire underwriter
Halifax Ins h 164 Castlefield av MO 4928 —Fredk T motorman TTC h
24 Dunfield rd HY 3272 — G mach Modern Tool Wks r 410A
Summerhill av — G Mrs h 1, 61 Wellesley — G Arthur barrister 1007,
320 Bay WA 6241 h 69 Regal rd KE 4045 — G Harry tailor Tip Top
Tailors h 55 Victor av HA 6853 — G S & Co (Geo S Martin & Percy
Reitapple) bldrs 506 465 Bay WA 4687 — Gavin C carp Massey-
Harris h 1275 Lansdowne av KE 6665 — Gavin H demonstrator U of
T h 23, 9 DeSavery cres MO 1879 — George h 91 Beaty av LL 6161
(act ser) — Geo r 206 John — Geo r 30 Lake Shore dr (New T) —
Geo blr mkr Leaside Block & Tile r 188 Cowan av (E Y) — Geo emp
CPR r 133 Shuter TR 0679 — Geo frt agt CPR h 437 Durie LY 5087 —
Geo lab Williamson Contr h 430 Roxton rd — Geo maintenance mn
PO r 800 Dovercourt rd LO 2996 — Geo mgr Soc for Crippled
Civilians Inc r 44 Curzon HA 2250 — Geo pol const r 145 Winchester
RA 5631 —Geo prod planner John Inglis h 216 Indian rd — Geo
repairer Stan Lane h 217 Cedarvale av (E Y) —Geo h 4 Donald av
(Silv) — Geo r 809 Dovercourt rd ME 6286 — Geo A h 752 Dufferin
— Geo A emp John Inglis h 7 Goodwood av — Geo A Morse opr CNT
h 147 Chaplin cres HU 7927 — Geo A vice-pres Jas Fisher Co Ltd h
86 Duplex av HY 5216 — Geo C h 84 Wineva av HO 9005 (act ser)
— Geo D r 190 Balliol MA 1997 (act ser) — Geo D r 26 Summerhill
av KI 0068 —Geo D ertkr Rosedale United Church h 264 Strathmore
blvd HA 0397 — Geo E acet Beauchamp & How h 8 Chesterjiill rd GE
4271 — Geo E foremn Dorn Envelopes h 891 Shaw — Geo F assmblr
Natl Cash Register r 28 Runnymede rd (Swan) JU 5311 —Geo F
assmblr Natl Cash Reg h 28 Runnymede rd (Swan) JU 5311 — Geo F
bldr h 50 Pritchard av (Rnny) LY 6135 — Geo G h 116 Atlas av (Oak)
KE 3726 — Geo H caretkr The Gifford House h 2A, 24-26 Gifford MI
7286 — Geo H emp Blantyre Dairy h 30 West av GE 4860 — Geo K
advtg mgr Wilson Pub h A, 345 St Clair av w MAR MARTIN Martin
Geo L photo engraver Rapid Grip & Batten h 138 Wineva av GR 2044
— Geo M foremn CPR h 69A Falrview av JU 9689 — Geo M supt
Luckett Loose Leaf h 56 Roseneath Gdns (Oak) LO 8163 —Geo R h
1032 Bathurst KE 3585 (act ser) — Geo S (G S Martin & Co) r 256
Dundas e — Geo T h 1316 Woodbine av (E Y) (act ser) — Geo W
sweeper John Inglis r 21 Eighth (New T ph 2291) — Georgina insp
Candn Acme Screw & Gear r 132 Pritchard av (La M) LY 7930 —
Georgina opr Anchor Cap r 13 Clinton pi — Gerald druggist Lloyd B
Woodman r 3414 Yonge — Gerald C cigars & tobacco confy 3414
Yonge h same — Gerald D slsmn Thompson-Heyland Lumber Ltd h
624, 398 Avenue rd MI 3864 — Gerald W emp Natl Steel Car h 110
Sherwood av MO 5819 — Gerald M r 208 Major KI 7035 (act ser) —
Geraldine stenog Ont Religious Education Council r 273 Woburn av
HU 5073 — Gerrard h 524 Pape av HA 7177 (act ser) — Gerrard P
opr TTC r 91A Empress cres — Gertrude assmblr Moffats Ltd r 9
Marshall blvd (Mt D) LY 8571 — Gertrude insp Canadian Aircraft r
597 Millwood rd MO 4633 — Gertrude wrpr Wonder Bakeries r 226
Shaw — Gertrude E sec A R Morton & Co r 46 Albany avenue —
Gertrude E (wid Herbt) h 498 Main (E Y) — Gilbert A press hd Candn
Hanson & Van Winkle h 43 Mahony av (Mt D) LY 4649 — Gilbert S
elk Imp Life r 369 Sunnyside av LL 5645 — Gladys C stenog Rapid
Grip r 97 Balsam av HO 3452 — Gladys T invoicing elk Candn
Laboratory Supplies r 145 Winchester — Glen W emp Gutta Percha r
1, 585V2 Bloor w ME 8419 — Gordon r 94 Humber blvd (Mt D) LY
0784 (act service) — Gordon r 562 Indian Grove (act service) —
Gordon r 58 Lippincott WA 0169 (act service) — Gordon draftsmn
Metallic Roofing Co r 197 Lisgar — Gordon mach Candn Acme Screw
& Gear h 149 Aylesworth av (Bch C) GR 2604 — Gordon milk
transport h 131 Chiltern Hill rd (Cedarvale) MO 0504 — Gordon stkpr
Belyea Bros h 177 Havelock LL 2356 — Gordon A ertkr CGE res
Wexford —Gordon E draftsmn Fruehauf Trailer r 197 Lisgar —
Gordon J opr Cannon Elect r 50 Westwood av — Gordon M insp Fire
Dept City Hall h 151 Roslin av HU 7706 — Gordon T r 580
Greenwood av GL 3453 (act service) — Gordon W florist 3107
Dundas w JU 5591 h 81 Fairview av MU 3851 — Grace emp Verybest
Specialty r 4 Ashley pi — Grace opr Tor Carpet r 538 Spadina av — -
Grace Mrs h 6, 19 Tennis cres GE 5236 —Grace (wid W H) h 304,
2857 Yonge MO 9245 — Greita E tchr Norway Pub Schl r 55 Victor av
HA 6853 — Gus lab Anaconda Amer Brass r 274 Sixth (New T) —
Gwendoline M cash Eatons h B2, 76-80 Grosvenor — Gwendolyn Mrs
h 117 Curzon — H emp MacLean Pub r 8 Grove av — 'H Douglas K
(Martin Ins Services) h 122 Old Orchard gr HU 8725 — -H Emerson
barr Day, Ferguson, Wilson & Kelly r 131 Havelock LO 1637 — H
Jaqueiine sec Trinity Coll h 29 Admiral rd KI 5471 — H Milton chem
engnr Dorn Tar & Chem Co h 19 Doug|as cres (E Y) RA 5635 —
Hannah (wid David) r 420 Coxwell av HA 7766 — Harold emp
Dunlop Tire r 59 Howard RA 1932 — Harold slsmn Silverwoods h 140
Glebemount av (E Y) GR 2780 — Harold A chief elk Candn Johns-
Manville h 301, 2745 Yonge HU 2745 — Harold A trav Pioneer Tailors
r 211 Langley av HA 2429 — Harold E elect Natl Refining h 72 Edna
av LL 1812 — Harold E mach Massey-Harris r 55 Parkway av LL 0759
— Harold F (Martin Bros) h 5, 286 Roncesvalles av LA 5785 —
Harold G mach Dorn Bridge h 12A Glenlake av LY 4935 — Harold G
supt Yonge St Mission h 381-3 Yonge EL 6096 — Harold H emp
Neptune Meters h 52 Arcadian Circle (Long B) — Harold J sales dept
B A Oil h 28 Wendover rd (Kngswy Pk) LY 0866 — Harriet (wid
Alfred) r 4 Highbourne rd HY 9511 — 'Harriet E (wid Fred) h 1, 1046
College KE 1493 — Harry r 155 Booth av EL 2859 — Harry r 50
Westwood av (E Y) GL 6403 (act service) — Harry asst shpr Musson
Book r 46 Chester av — Harry emp Aluminum Co of Can r 4190
Dundas w (La M) LY 8426 — Harry guard John Inglis h 23 Cheston
rd HU 7936 Alphabetical, White Page 857
 MARTIN Martin Harry hlpr Birks-EI I is-Ryr ie r 339 Pape a v
— -Harry pntr r 48 Alexander KI 8677 — Harry plant supt Donlands
Dairy h 42 Sammon av (E Y) GE 4884 — -Harry stk handler Gair Co
h 6 Monteith — Harry tlr h 8 Napanee — Harry tire repair Simpsons r
15 Osborne av GR 1904 — Harry A slsmn Candn Life Assurance h
334 Broadway av (Nth Y) HU 1513 — Harry B (Empire Stamp Co) h
26 St Leonards av HY 9384 — Harry B post stamp dir h 116 Erskine
av MO 3832 — Harry D arch h 59 Hopedale av (E Y) GL 3611 —
Harry E h 114 Birch av (act service) — Harry R emp Moffats Ltd h 9
Marshall blvd (Mt D) LY 8571 — Harry V draughtsrrm Gas Co h 234
Cedarvale av (E Y) HO 4196 — Harvey h 6 Geneva av KI 8651 (act
ser) — Harvey r 324 St Germain av MO 8693 (act ser) — Harvey A
tool mkr John Inglis h 546 Strathmore blvd HO 2852 — Harvey W
mixer Imp Varnish h 57 Ashburnham road — Hazel H elk Dept Pub
Health r 29 Admiral rd KI 5471 — Hazel 0 stenog Globe & Mail r 25
Cortland av HU 8722 — Helen r 71 Auburn av LL 0287 —Helen bkpr
The Douglas & Marshall Press r 2430A Bloor w — Helen emp Can
Aircraft Leaside r 412, 1930 Yonge MA 1839 — Helen emp Genl
Engnrg r 266 Dupont RA 3797 — Helen hrdrsr h 6, 147 Vaughan rd
(Wych) LO 2923 — Helen wtrs Ace Drug r 301 Markham — Helen D
Mrs tchr Malvern Coll Inst r 311A, 321 Bloor w — Helen E stenog
Meteorological Serv r 3 Buttonwood avenue — Helen L elk Eatons r
552 Glebeholme blvd GR 5886 - — Helen M threader Tor Carpet Mfg
r 42 Dunn avenue — Henry (Super Body & Fender Wk) h 291 Rogers
rd KE 4760 — Henry grinder CGE Royce Av Wks r 2285 Dundas west
— Henry mech h 127 Markham — Henry E fnshng foremn Natl
Cabinet Co h 36 Craighurst av MO 2261 — Henry G h 99 Runnymede
rd (Swan) LY 2427 — Henry J barr 503, 357 Bay EL 5645 h 46 Elm
av RA 4074 — Henry J slsmn Graydon Hat Co h 69 Belhaven rd GR
9178 — Henry W emp Dorn Oxygen Co h C 4, 98 Leuty avenue —
Herbert (McCallum & Martin) h 834Va College — Herbert blocker
North The Hatter r 25 Gordan av — Herbert emp Northern Elect h
445 Soudan av — Herbert E r 15 Arundel av GE 6806 (act ser) —
Herbert F emp Northern Elect r 31 Garden av — Herbert G slsmn h
27 Alexandra blvd HU 6718 — Herbert J suprvsr Eatons h 174
Glenview av HU 3288 — Herbert W grainer Rolph-Clark- Stone h 15
Arundel av GE 6806 — Herbert W slsmn r 99 Runnymede rd (Swan)
LY 2427 — Herbert W slsmn PO h 220 Glenforest rd MA 3824 „ -
Hewitt Containers Ltd Geo H Kischel sales rep boxes 707, 137-43
Wellington w WA 5652 — Hilda M with Steele, Briggs r 267 Perth av
LL 6395 — Hilda V Mrs emp Blind Craft Shop r 486 Jarvis MI 1585 —
Homer slsdk John's Cigar Store h 2831 Dundas west — Horace supt
h 103, 790 Eglinton av w (Fst H) MO 5560 — Horace R carp h 152
Caledonia rd KE 1079 — Howard stkpr Borden Co r 28 Eastdale av (E
Y) HO 3153 — Howard trk drvr Swift Candn h 994 Weston rd (Mt D)
— Howard E r 28 Harcourt av HA 4143 (act ser) — -Hubert W
gymnasium instructor U of T Athletic Assn h 24 Queen Mary Dr
(Kngswy Pk) LY 1901 — Hugh pntr Bd of Education h 884A College
KE 8602 — Hugh slsmn Eatons r 17 St Joseph — Hugh riveter Natl
Steel Car h 354 Merton — Hugh D r 264 Strathmore blvd HA 0397
(act service) — Hugh M tool mkr improver Duplate Tool & Die r 7
Carey rd HY 1829 — Hugh W h 131 Havelock LO 1637 — Hyman
pdlr h 390 Manning av KE 6959 — I Mrs tchr Hartman Jones
Memorial Schl r 23 Dunkirk rd (E Y) — Ian elect engnr REL r 132
Parkhurst blvd (Leas) MO 3146 — Ida Mrs h 48 St Patrick — Ida M
(wid Harold) h 412 Beresford av JU 2175 — Ida M (wid Noel) h 596
Brock av ME 0766 — Ilene V stenog Supreme Court r 2, 30
Woodlawn av w — Insurance Services (H Douglas K Martin) genl ins
agts 902, 156 Yonge AD 8237 —Irene h 16, 921 St Clair av w LL
6185 — Irene r 50 Westwood av (E Y) GL 6403 Martin Irene elk Auto
Elect r 1659 Gerrard e —Irene emp REL r 56 Roseneath gdns (Oak)
LO 8163 — Irene glassblower 0 H Johns Glass r 153 Alameda
avenue — Irene swtchbd opr Neighborhood Workers Assn r 75 Awde
LL 4714 — Irving M division mgr Borden Co h A23, 477 Bayview av
(Leas) — Irwin coll Simpsons h 88 Dewhurst blvd GL 4420 — Isabel
Mrs elk Eatons r 36 Maitland — Isabel (wid Sami) h 92 Granby EL
3014 — Isobel tchr r 4198 Dundas w (La M) LY 7240 — Isobel A
nurse Dorn Bridge r 4, 54 Foxbar rd KI 2873 — Isobel H elk Morgan
Nicholson Ltd r 58 Orchard View blvd — Isabel M stenog Eatons r 81
Earl Grey rd GL 1225 — -Ivan G hlpr Gair Co h 148 Barton av ME
6765 — J h 924 Eglinton av w (Fst H) — J emp John Labatt Ltd r 31
Kenilworth av HO 5424 — J Arthur r 110, 2707 Yonge MO 7812 (act
service) - — J Bruce (J Bruce Martin Laboratories) and toilet goods
21 Nelles av h same LY 3256 — J Bruce Laboratories (J Bruce
Martin) toilet prep 1536 Dundas w — J Jos lab MacLeans r 44
Dentonia Pk av (E Y) GR 8164 — Jack r 111 St Patrick EL 8076 —
Jack pntr and dec h 1, 525 Kingston rd HO 9037 — Jack slsmn
Barkers Bread h 409 Deloraine av (Nth Y) HY 0984 — Jack T r 255
Strathmore blvd HA 0960 (act service) — Jackson gro 154 Morrison
av h same KE 7011 — Jas h 6 Bain av GL 4089 — Jas r 76 Fourth
(New T) (act ser) — Jas h 321 Gledhill av (E Y) (act service) — Jas r
82 Lappin av ME 8531 — Jas h C3, 56 Maitland (act ser) — Jas r 201
Oak (act ser) — Jas buffer and plshr Candn Acme Screw & Gear h
228 Margueretta LL 8314 — Jas car hlpr CNR h 19 Mountalan av —
Jas conveyor opr Gas Co h 254 Chambers av (Silv) — Jas drvr Crown
Taxi r 137 Westmount av (Oak) ME 6189 — Jas emp Blue Door
Lunch r 55 Prince Arthur av — Jas factory supt Adanac Golf Clubs h
190 Balliol MA 1997 — Jas foremn Peerless Wine Mfrs h 132
Marchmount rd LO 7339 — Jas jr golf club mkr Adanac Golf Clubs r
190 Balliol MA 1997 — Jas hatter Robt Crean Co h 100 Berkshire av
— Jas lab Dept St Clng h 52 Kerr rd HA 5367 — Jas mldr CGE Royce
Av Wks res Maple — Jas reprmn TTC h 3 Doel av HA 1567 — Jas
sheet metal wkr Massey-Harris h 25 Greyton cres (Frbk) KE 7213 —
Jas trackmn TTC h 58 Lippincott WA 0169 — Jas A h 75 Awde LL
4714 — Jas A (Martin's Sporting Goods) h 26 Glenwood crescent (E
Y) — Jas A electro plater Coleman Lamp Co h 226 River — Jas A
emp Toronto Shipbuilding h 25 Gordon — Jas A lab Dept St Clng h
201 Oak — Jas A stk elk Gordon, Mackay & Co h 88 Concord av LO
4542 — Jas B foremn Dept St Clng h 85 Jackman av GE 4865 — Jas
C h 19 Baltic av HA 4995 — Jas C h 13 Dingwall av GL 6959 — Jas C
golf club mkr Burke-Thumm r 421 Jarvis — Jas D r 132 Pritchard av
(La M) JU 7930 (act service) — Jas D G r 101 Neville Pk blvd HO
6528 — Jas E hatter Robt Crean & Co r 100 Berkshire avenue — Jas
F r 83 Empire av HA 9679 (act ser) — Jas F emp John Inglis h 13
Dingwall av GL 6959 — Jas G elk A E Ames & Co h 101 Neville Park
blvd HO 6528 — Jas G jr opr Dom Bridge r 101 Neville Park blvd HO
6528 — das H r 159 Symington av LL 5307 (act ser) — Jas H insp
Yale & Towne h 65 Alameda av (Fairbank) ME 3243 — Jas H stone
ctr McIntyre Co h 1, 1 Chester avenue — Jas J elk C N Exp h 1659
Gerrard e GR 6995 — Jas J glassblower 0 H Johns Glass h 1, 153
Alameda av (Frbk) — Jas J uphol Tor Rattan h 436 Harvie av (Frbk)
KE 8407 - — Jas K elk Neilson's h 417V2 Westmount av (Frbk) KE
3193 — Jas L acct R J Lovell Co h 272 Chisholm av (East York) — Jas
M elk Land Titles Off h 161 Sherwood av MO 1012 — Jas 0 r 268
Sherbourne — Jas P lab Gas Go h 488 Kingston rd — Jas R r 92
Sumach AD 3572 (act ser) — Jas R cashier Chartered Trust h 12,
191 Eglinton av w — Jas T dept foremn Bausch & Lomb h 8 Minton
place (E Y) GE 2160 — Jas T mach John Inglis h 128 Medtend — Jas
W brklyr h 51 Coleman av GR 1210 — Janet off sec Law Insurance
Agencies Ltd h 3, 37 Albemarle av HA 3394 — Janet (wid Alex) h
129 Shanly LA 7432 — Jay A chemist Anaconda Amer Brass r 340
Brunswick av KI 9657 — Jean r 439 Sherbourne MI 8478 — Jean sec
Richard De Boo Ltd r 458 Glenlake avenue — Jean Mrs (Audrey's Hat
Shop) h 4, 636 Danforth av GE 4623 — Jean Mrs opr Eatons r 260
Delaware av — Jean (wid S Chas) h 177 Lippincott MI 4497 Martin
Jean L stenog Eatons r 110, 2707 Yonge MO 7812 — Jean M emp
Brown's Bakery r 109 Caroline av — Jennie Mrs h 50 Westwood av
(E Y) GL 6403 — Jennie (wid Robt) h 7 Clinton pi — Jessie stenog
Eatons r 312, 2707 Yonge - — Jessie Mrs r 158 Blackthorn av JU
5508 — Jessie C h 44 Alvin av HY 5155 — Jessie E r 30, 15
Sherwood av MO 4500 — Jessie F Mrs elk Bank of N S (Broadview
and Gerrard) r 33 Langley av — Jessie I nurse h 170 Spadina rd KI
6544 — John r 86 Bellwoods av LA 4809\ — John h 27 Euclid av WA
3719 — John jr r 600 Gladstone av LO 5421 (act service) — John h
313 Greenwood av GL 6170 — John r 148 John — John r 3 Wilkins
av — John (White Lunch) h 152 Queen e AD 6852 — John clnr
Western Hosp h 143 Lippincott — John const Moffats Ltd h 25 Main s
(Wstn ph 1065M) — John customs broker 15, 32-34 Front w WA
2326-7 res Oakville — John designer Novelty Textile Printing Works h
488 Victoria Park av HO 5568 — John dry clnr r 35 Ryerson av —
John emp CGE h 122 Eileen av (La M) — John emp Royal York Hotel
h 122 Winchester MI 5857 — John knitter F Longdon & Co Ltd r 44
Dentonia Park av — John lab r 126 Bond EL 5804 — John lab Eatons
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